From 5G smart hospitals to 6G-enabled learning hospitals: a governance-oriented framework for healthcare technology, policy, and responsible deployment.

Objectives: Discussion of 6G in healthcare often moves directly from anticipated network capabilities to proposed clinical applications, although application-level evidence, current connectivity alternatives, and 6G-specific evidence differ substantially in maturity. This narrative review develops an evidence-calibrated, governance-oriented framework for prospective 6G-enabled learning hospitals and examines when future 6G may add meaningful value beyond existing infrastructure. Methods: A multidisciplinary narrative synthesis covered smart hospitals, learning health systems, 5G/6G communication, IoMT, edge-cloud computing, AI/XAI, robotics, digital twins, cybersecurity, interoperability, implementation, and digital-health governance. Structured searches of PubMed, Web of Science, IEEE Xplore, and Google Scholar covered 1 January 2010-31 January 2026, supplemented by relevant standards, regulatory and policy sources, and targeted recent studies. Evidence was interpreted using an author-developed Evidence Maturity Classification (EMC) spanning demonstrated implementation, clinically grounded empirical, technical/benchmark, and prospective evidence. Results: The synthesis produced a seven-layer architecture, nine use-case analyses, a capability and evidence-maturity matrix, a twelve-domain risk-governance-metric framework with decision gates, a five-phase implementation roadmap, and an executive checklist. Across use cases, evidence for the underlying healthcare application was more mature than evidence for incremental benefit specifically attributable to 6G. Existing wired networks, Wi-Fi, private cellular systems, 5G/5G-Advanced, and edge-cloud infrastructure already support many monitoring, telemedicine, imaging, home-care, logistics, maintenance, and selected teleoperation functions. Future 6G is therefore most relevant when meaningful residual capability gaps remain, particularly combinations of mobility continuity, predictable end-to-end service, dense device coordination, multimodal synchronization, integrated sensing or positioning, and communication-computing orchestration. Conclusions: 6G adoption should follow demonstration of clinical or operational value, a residual capability gap, and governance readiness. Hospitals should use the least complex infrastructure that meets requirements, generate evidence through risk-proportionate pilots, and scale advanced connectivity only when incremental value is demonstrated against optimized current alternatives. The framework provides a structured basis for these decisions but requires prospective validation across diverse hospital settings.