A Post-Quantum Secure Architecture for 6G-Enabled Smart Hospitals: A Multi-Layered Cryptographic Framework

Future 6G-enabled smart hospital infrastructures will support latency-critical medical operations such as robotic surgery, autonomous monitoring, and real-time clinical decision systems, which require communication mechanisms that ensure both ultra-low latency and long-term cryptographic security. Existing security solutions either rely on classical cryptographic protocols that are vulnerable to quantum attacks or deploy isolated post-quantum primitives without providing a unified framework for secure real-time medical command transmission. This research presents a latency-aware, multi-layered post-quantum security architecture for 6G-enabled smart hospital environments. The proposed framework establishes an end-to-end secure command transmission pipeline that integrates hardware-rooted device authentication, post-quantum key establishment, hybrid payload protection, dynamic access enforcement, and tamper-evident auditing within a coherent system design. In contrast to existing approaches that focus on individual security mechanisms, the architecture introduces a structured integration of Kyber-based key encapsulation and Dilithium digital signatures with hybrid AES-based encryption and legacy-compatible key transport, while Physical Unclonable Function authentication provides hardware-bound device identity verification. Zero Trust access control, metadata-driven anomaly detection, and blockchain-style audit logging provide continuous verification and traceability, while threshold cryptography distributes cryptographic authority to eliminate single points of compromise. The proposed architecture is evaluated using a discrete-event simulation framework representing adversarial conditions in realistic 6G medical communication scenarios, including replay attacks, payload manipulation, and key corruption attempts. Experimental results demonstrate improved security and operational efficiency, achieving a 48% reduction in detection latency, a 68% reduction in false-positive anomaly detection rate, and a 39% improvement in end-to-end round-trip latency compared to conventional RSA-AES-based architectures. These results demonstrate that the proposed framework provides a practical and scalable approach for achieving post-quantum secure and low-latency command transmission in next-generation 6G smart hospital systems.