<p>This study explores the role of blockchain technology (BT) in enabling decarbonisation within healthcare supply chain management (SCM) in the context of Industry 4.0. A novel hybrid methodological framework combining the fuzzy spherical analytical hierarchy process (FS-AHP) and the Z-number logarithm methodology of additive weights (ZLMAW) is developed to address the complexities and uncertainties inherent in this domain. The research identifies critical factors influencing the adoption of BT in decarbonised SCM and ranks healthcare companies based on their suitability for implementation. The results highlight the lack of a robust scope framework as a priority concern and demonstrate the efficacy of the proposed model in advancing sustainable practices. This work contributes to theoretical advancements, by integrating multi-criteria decision-making (MCDM) techniques with blockchain in SCM, and practical insights, by offering a scalable approach to supply chain decarbonisation. The findings bridge gaps in the literature by addressing the intersection of blockchain, Industry 4.0, and sustainability in healthcare, presenting actionable strategies for supply chain optimisation.</p>