Translating IT capabilities: Linking enabling infrastructure to digital transformation in hospitals—Sustainable digital enablement framework

• A novel effort-based lens on hospital digital transformation. • New concepts: Translating IT capabilities and enabling IT infrastructure. • Enabling IT infrastructure's impact is fully mediated by translating IT capabilities. • The study underscores the importance of human-centric IT strategies in hospital digital transformation. • Novel hospital framework: Sustainable Digital Enablement Framework. The paradox of hospitals investing heavily in IT infrastructure, which can often be ineffective in their digital transformation efforts, is a rich, even frustrating scenario that warrants a deeper understanding. Moving beyond just outcome, our effort-focused approach examines how IT infrastructure supports sustainable digital transformation as an ongoing effort, reflecting real-time resource utilization, strategic direction, and organizational commitment crucial for success. We propose that a robust IT infrastructure potentially enhances an organization's capacity to enable its IT capabilities, fostering organizational readiness and self-efficacy, and encouraging more ambitious efforts in digital initiatives. We introduce two new concepts, translating IT capabilities and enabling IT infrastructure, to elucidate novel mechanisms through which IT infrastructure influences transformation efforts. PLS-SEM analysis of 124 hospital IT managers reveals that enabling IT infrastructure's impact is fully mediated by three translating IT capabilities: IT human, IT relationship, and IT architecture capabilities, with the IT human capability exerting the strongest influence. Our Sustainable Digital Enablement Framework offers novel insights, providing a dynamic roadmap for hospitals, policymakers, and stakeholders to enhance sustainable digital transformation efforts. The study also contributes from a theoretical point of view by providing further empirical confirmation of the fact that investing in IT's "soft" side (human skills, relationships, architecture) is as crucial as, if not more crucial than, the "hard" infrastructure for sustainable digital transformation and strategic alignment.