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There is evidence that quality improvement projects developed with the participation of patients and family members are more likely to result in a sustainable change. To identify the intervening factors is an important step in promoting and supporting patient and family members’ engagement.

A survey was carried out with 90 hospitals. A total of 35 intervening factors were evaluated by the healthcare professionals from the quality area using a Likert scale. Factor analysis was applied to identify the relationship among the factors and cluster analysis and the standardized scores for each new latent variable were obtained to observe the association between them and hospitals profile. Cluster analysis allowed to group the hospitals with similar responses and to analyze whether there was any association with the profile of the institutions.

A total of ten intervening factors are identified: two in the financial dimension, five in the structural and three in the personal and cultural. The standardized scores of latent variables suggest that the financial factors could be affected by the hospital capacity. The structural factors could be impacted by the accreditation status, location (region) and administrative control (ownership). And the personal and cultural factors could be by the location and dominant organizational culture. All of factors are influenced by the performed quality management activities. The cluster analysis allowed the identification of three groups in the financial dimension, and four in the other two dimensions. Except for the accreditation status in the personal and cultural dimension, no evidence of association between the groups and the variables raised to characterize the profile of the hospitals was found.

The study contributed to identify the relationship among the intervening factors turning possible to simplify and reduce them more comprehensively than those originally identified in the literature and at the same time maintaining the representativeness of the original variables.

A maturity model for Industry 4.0 (I4.0 MM) with influencing factors is designed to address maturity issues in adopting Industry 4.0. Standardisation in I4.0 supports manufacturing industry transformation, forming reference architecture models (RAMs). This paper aligns key factors and maturity levels in I4.0 MMs with reputable I4.0 RAMs to enhance strategy for I4.0 transformation and implementation.

Three steps of alignment consist of the systematic literature review (SLR) method to study the current published high-quality I4.0 MMs, the taxonomy development of I4.0 influencing factors by adapting and implementing the categorisation of system theories and aligning I4.0 MMs with RAMs.

The study discovered that different I4.0 MMs lead to varied organisational interpretations. Challenges and insights arise when aligning I4.0 MMs with RAMs. Aligning MM levels with RAM stages is a crucial milestone in the journey toward I4.0 transformation. Evidence indicates that I4.0 MMs and RAMs often overlook the cultural domain.

Findings contribute to the literature on aligning capabilities with implementation strategies while employing I4.0 MMs and RAMs. We use five RAMs (RAMI4.0, NIST-SME, IMSA, IVRA and IIRA), and as a common limitation in SLR, there could be a subjective bias in reading and selecting literature.

To fully leverage the capabilities of RAMs as part of the I4.0 implementation strategy, companies should initiate the process by undertaking a thorough needs assessment using I4.0 MMs.

The novelty of this paper lies in being the first to examine the alignment of I4.0 MMs with established RAMs. It offers valuable insights for improving I4.0 implementation strategies, especially for companies using both MMs and RAMs in their transformation efforts.