This study examines the association between telemedicine adoption and healthcare management efficiency, with leadership support acting as a mediator, at King Fahad Hospital in Saudi Arabia. A core issue is that adopting technology alone does not automatically improve managerial efficiency, as organisational elements especially leadership backing often determine the extent of the benefits achieved. Grounded in the Resource-Based View framework, we propose that telemedicine adoption improves efficiency both directly and indirectly via leadership commitment, resource allocation, and strategic direction. We employed a positivist, correlational cross-sectional design. We collected data from 422 healthcare professionals and administrative staff through a structured, self-administered questionnaire. We analysed the data using Partial Least Squares Structural Equation Modelling with 5,000 bootstrap subsamples. The measurement model showed satisfactory psychometric properties: all indicator loadings were above 0.70, composite reliability exceeded 0.91, and average variance extracted values exceeded 0.57. Discriminant validity was established by applying the Heterotrait-Monotrait ratio. The structural model explained 58% of the variance in healthcare management efficiency. All direct effects were statistically significant at p < 0.001. Telemedicine adoption had a notable positive direct effect on efficiency (? = 0.29, t = 4.85) and a robust effect on leadership support (? = 0.64, t = 13.27). Leadership support was associated with a notable increase in efficiency (? = 0.46, t = 7.62). Mediation analysis indicated that leadership support partially mediated the relationship, with an indirect effect of 0.294 (t = 6.18, p < 0.001) and a Variance Accounted For of approximately 50.3%. The total effect of telemedicine adoption on efficiency was 0.584. These results indicate that the productivity gains from telemedicine are greatly reinforced when hospital administrators actively champion its implementation. Hence, healthcare administrators and policymakers should recognise that successful digital health transformation depends on both technology funding and active organisational direction to achieve operational and administrative benefits.
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