Institutional Governance for Sustainable Utilisation of Healthcare IoT Technologies: Moving Beyond Technology...

The digital transformation of healthcare has become a key component of building resilient and sustainable health systems. However, the long-term sustainability of digital health technologies depends not only on user acceptance but also on the institutional governance conditions that shape how these technologies are implemented and utilised in practice. This study examines how institutional factors shape the sustainable utilisation patterns of Internet of Things (IoT) technologies in regulated healthcare environments, with hospital IoT-based asset management systems, a mature and widely deployed use case in China's public hospitals, providing the empirical context for the investigation.

Drawing on institutional theory and the Technology Acceptance Model (TAM), we conceptualise user perceptions as behavioural micro-foundations through which institutional conditions influence technology utilisation. A survey of 293 healthcare professionals from two large public hospitals in China was analysed using Structural Equation Modelling (SEM), incorporating mediation and Multi-Group Analysis (MGA).

The results demonstrate that technical compatibility (TC) significantly enhances perceived ease of use (PEU) (β = 0.40), while organisational support (OS) positively influences both perceived usefulness (PU) (β = 0.35) and PEU (β = 0.30). Conversely, regulatory compliance (RC) negatively affects PU (β = -0.25) and PEU (β = -0.20), revealing a tension between accountability requirements and operational efficiency. The model explains between 58% and 67% of the variance in key constructs.

Overall, the findings indicate that sustainable utilisation patterns depend on alignment between technological capabilities and institutional governance conditions, with user perceptions operating as behavioural micro-foundations through which institutional effects are transmitted. By integrating institutional theory with technology acceptance research, this study contributes a governance perspective for understanding sustainable digital transformation in healthcare systems and provides practical insights for designing interoperable, compliant, and supportive digital health infrastructures to enhance hospital operational efficiency and quality of care.