What drives E-Health usage? Integrated institutional forces and top management perspectives

Abstract

As hospitals increase their reliance on healthcare information technology to deliver services, there is a growing need to understand how to promote E-Health innovation usage within a hospital. Drawing on institutional theory and top management perspectives, we develop a theoretical model that explains how E-Health usage is influenced by external institutional forces and top management support. Three types of institutional forces: mimetic, coercive and normative pressures and two actions: top management beliefs and E-Health championing by which top management champions E-Health usage are identified and examined. Our empirical results show: 1) mimetic and coercive pressures positively affect top management beliefs and mimetic pressure also positively affects E-Health championing, 2) the effect of mimetic pressure on top management beliefs and E-Health championing is significantly stronger than other pressures, 3) both top management beliefs and E-Health championing promote E-Health usage, and 4) institutional forces' influence on E-Health usage is mediated by top management support. These findings highlight the important role of top management support in mediating the effect of institutional forces on E-Health usage and provide insight into how hospitals govern the institutional forces that drive top management support for E-Health innovations, thereby leading to actual E-Health usage.