Systematic Literature Review: Regulatory Uncertainty and Its Impact on Hospital Project Performance

Abstract

Hospital infrastructure projects are inherently complex due to their exposure to dynamic healthcare regulations, fiscal constraints, long-term financing arrangements, and technological innovation. Regulatory uncertainty has emerged as a critical institutional factor influencing project performance; however, its impact within hospital projects remains insufficiently synthesized. This study employs a Systematic Literature Review (SLR) following PRISMA 2020 guidelines, searching exclusively through Google Scholar, to analyze 19 peer-reviewed studies published between 2022 and 2026 that examine the relationship between regulatory uncertainty and project performance. The findings indicate that 42.1% of the reviewed studies report a positive association between regulatory uncertainty and cost overruns, while 36.8% identify significant links to schedule delays. The effect on quality outcomes is non-linear: some studies reveal quality deterioration due to time and budget pressures, whereas others demonstrate that stable and stringent regulatory frameworks enhance technical quality and accountability. These mixed findings suggest a regulatory–performance paradox, where regulatory volatility increases risk and inefficiency, but regulatory stability strengthens governance and long-term project sustainability. This study positions regulatory uncertainty as an institutional mediator that links governance structures, financing mechanisms, and project performance outcomes in hospital infrastructure development. The proposed conceptual framework offers important implications for policy design and risk management in healthcare infrastructure projects.