Unveiling the mechanisms influencing service efficiency in Chinese hospital portal sites: evidence from DEA and fsQCA analysis

Hospital portal sites (HPSs) have emerged as critical digital touchpoints connecting millions of patients, including those with disabilities, chronic conditions, and participation challenges, with healthcare services. As complex information systems, the service efficiency of HPSs, referring to their ability to convert resource inputs into user adoption, is critical but remains underexplored in the Chinese healthcare context. This study evaluates the service efficiency of Chinese HPSs and identifies factors influencing it from a user-centered perspective. A mixed-methods approach was adopted. In Phase 1, the service efficiency of 73 HPSs was assessed using Data Envelopment Analysis (DEA), measuring how effectively input resources are translated into user engagement. In Phase 2, fuzzy-set Qualitative Comparative Analysis (fsQCA) was applied to survey data from 1,473 users to uncover configurations of e-service quality attributes that drive or hinder efficiency. DEA results revealed that 68% of the HPSs exhibited low efficiency, with an average score of 0.84. fsQCA analysis identified two high-efficiency configurations and one low-efficiency configuration. Factors were categorised as "motivators" (fulfillment, information utility, interaction quality) that promote high efficiency and "hygiene factors" (convenience, privacy/security, and system quality) that prevent inefficiency but do not directly enhance it. Our findings offer practical implications for hospital IT managers by revealing critical mechanisms that affect digital service efficiency. Enhancing these factors can improve HPS performance, increase patient adoption, and support broader digital health goals, especially in populations requiring long-term care and rehabilitation support.