Salutogenic integration of green practices and digital services in the Indonesian health-care sector: modelling effects of perceived quality and sustainable brand image

Purpose This study aims to investigate how integrating green practices and digital service-based salutogenic approaches in Indonesia’s health-care sector can enhance perceived service quality, patient coherence and a sustainable brand image. It fills theoretical gaps in modelling integrative health-care service practices, incorporating environmental sustainability and digital innovation. Design/methodology/approach This study uses an quantitative approach with cross-sectional survey to assess the impact of green practices and digital service integration on perceived health-care quality, sense of coherence and sustainable brand image in Indonesian hospitals. Data were collected from 264 hospital patients through purposive sampling and analyzed using partial least square-structural equation modelling (PLS-SEM) via SmartPLS version 4. Findings This study reveals that green health-care practices positively impact perceived quality of care, highlighting sustainable design’s role in enhancing service perception. Digitalization also positively affects perceived quality and patient coherence, as it improves accessibility and patient-provider interaction. The sense of coherence among patients, fostered by quality and sustainable service environments, significantly enhances brand image, emphasizing the role of salutogenic design. Perceived quality mediates the effects of green and digital innovations on coherence, while coherence itself significantly mediates the relationship between perceived quality and sustainable brand image. Gender differences were found in the impact of green practices on coherence, with women showing stronger responses. Research limitations/implications This study offers actionable guidance for health-care providers in Indonesia to adopt green practices and digital services with a salutogenic approach. Priorities include investing in eco-friendly building designs to enhance patient experience, digitalizing services for accessible and transparent care and educating patients on sustainable practices to strengthen brand perception and patient commitment. Originality/value This is among the first studies to model how salutogenic principles, green practices and digital services interact to shape psychological and branding outcomes in a developing country’s health-care context. It provides a novel theoretical extension by positioning the sense of coherence as both an outcome and a mediator influenced by institutional design.