Background <p>Nascent smart hospitals are developing as an essential yet challenging response to the healthcare industry’s digital revolution. However, there is limited understanding of the lived experiences of the stakeholders involved in this transition, especially in countries like Iran, characterized by distinct structural, cultural, and technological factors that complicate the process.</p> Methods <p>This qualitative, interview-based study involved 17 key stakeholders, including presidents, managers, experts, consultants, and healthcare professionals who engaged in the planning, development, or implementation of smart hospitals. Semi-structured interviews were conducted between February and April 2025, lasting from 20 to 126&#xa0;min, and were analyzed using Braun and Clarke’s six-phase thematic analysis approach.</p> Results <p>The qualitative data analysis identified 10 themes, 25 sub-themes, and 151 detailed codes. These findings highlight the multifaceted challenges to smart hospital transformation, including systemic performance weaknesses, technological limitations, organizational inefficiencies, security and ethical risks, insufficient skills and literacy, weak decision-making and adoption, governance and policy gaps, financial and investment inefficiencies, global crises, and conceptual deficiencies. Overall, the results emphasize the multidimensional and context-dependent nature of the smartization process in healthcare.</p> Conclusion <p>This study elucidates the challenges as well as the structural, cultural, and strategic requirements that must be addressed for the successful implementation of smart hospitals in Iran. The insights provided extend beyond a single national context, serving as a guide for understanding and navigating the global challenges of smart healthcare transformation for policymakers, hospital managers, investors, technology developers, consultants, and global health leaders who must collectively define the future of smart healthcare.</p>