Integrated Institutional Transformation Theory (IITT): Toward an Institutional Theory for the Transformation of Primary Healthcare Centers Through the Tikena17 Conceptual Framework.

Primary healthcare centers are fundamental to healthcare systems, yet sustainable institutional transformation remains constrained by fragmented governance, disconnected institutional structures, and the absence of an integrated institutional perspective, as existing frameworks largely address governance, institutional performance, quality improvement, integrated care, and institutional learning as separate domains rather than components of a unified institutional system. This study proposes the Integrated Institutional Transformation Theory (IITT) as a theoretical perspective for explaining institutional transformation in primary healthcare centers and introduces the Tikena17 Institutional Transformation Framework (Tikena17-ITF) as its conceptual representation. A conceptual theory development methodology was employed using a critical integrative review of institutional management and healthcare management literature, wherein systems thinking principles were applied to synthesize major theoretical traditions into a proposed integrated perspective on institutional transformation, followed by the development of a conceptual framework and a set of theoretical propositions. The proposed theory conceptualizes institutional transformation as a dynamic systemic process emerging from the interaction of interconnected institutional components rather than isolated institutional functions. Consistent with this perspective, the Tikena17-ITF represents institutional transformation through five interconnected layers comprising 17 institutional components. The proposed theory and framework offer a conceptual foundation for understanding institutional transformation in primary healthcare centers and for generating hypotheses that can be examined through future empirical research, implementation studies, institutional assessment, and validation across diverse healthcare settings. Their potential contribution to healthcare value, institutional reliability, accountability, maturity, and long-term sustainability remains subject to empirical evaluation.