<![CDATA[This study describes the strategic transformation of Prof. Dr. R. Soeharso Orthopedic Hospital, Indonesia’s national orthopedic referral center, using a five‑pillar framework: subspecialty development, advanced technologies, infrastructure and rehabilitation, alignment with national health priorities, and structured monitoring. A mixed-methods case study design was employed, integrating qualitative thematic analysis of institutional and policy documents with longitudinal quantitative analysis of performance data spanning 2019–2025. Institutional documents and national policy sources were analyzed thematically and benchmarked against leading international orthopedic hospitals. Service indicators showed substantial growth after the COVID‑19 downturn: total outpatients increased by 54.5% (89,705 to 138,604), surgical procedures by 157.9% (4,661 to 12,024), and hospitalizations by 106.7% (5,014 to 10,365). Bed occupancy recovered to 68.0%, while average length of stay declined from 4.81 to 3.74 days, indicating improved efficiency. Subspecialty outpatient volume rose 358%, with spine and adult reconstruction services showing the fastest growth. Transformation milestones included 100% EMR implementation across 24 clinical units, six dedicated subspecialty operating theatres, SNARS accreditation, and formal designation as a Main Provider Teaching Hospital in 2024. The framework offers a context‑specific, replicable model for orthopedic service transformation in low‑ and middle‑income countries.]]>
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