Purpose This study investigates the relationship between Groupware usage (GU) at the individual level and healthcare sustainable performance (SP) at the organisational level, with e-collaboration effectiveness (eCe) as a mediator and trust (Tr) as a moderator. The research aims to provide theoretical and practical insights into how collaborative technologies can foster sustainable practices in healthcare organisations. Design/methodology/approach A multilevel structural equation modelling (MSEM) approach was employed to examine the cross-level relationships among the study variables. Data were collected from 1,093 healthcare professionals across five major public hospitals, Iraq, using a two-wave survey design. The hypothesised relationships were tested using R and RStudio v4.4.1, ensuring robustness in the analysis of nested data structures. Findings The findings confirm that GU positively influences eCe, which in turn enhances healthcare SP. Additionally, Tr significantly moderates the relationship between GU and eCe, indicating that a trust-enhanced environment strengthens collaborative efforts. The results further highlight that the indirect effect of GU on SP is stronger at the organisational level than at the individual level, reinforcing the crucial role of eCe in translating individual contributions into broader sustainability outcomes. Originality/value This study contributes academically by developing a multilevel performance management perspective, showing how micro-level digital practices scale into organisational sustainability outcomes through collaborative capabilities. It extends socio-technical and collaboration theories by positioning e-collaboration effectiveness as a core performance-enabling mechanism in healthcare systems, while reconceptualising trust as a contextual capability amplifier. Practically, the findings inform healthcare managers on how to design trust-based digital environments to enhance coordination, efficiency and long-term sustainable performance.
Tawfeeq et al. (Thu,) studied this question.