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In this manuscript we report the findings from an in-depth case study about the factors that determine IT outsourcing success in the healthcare industry. Healthcare organizations in Taiwan are faced with increasing institutional pressures in the forms of hospital accreditation systems and national insurance program requirements. We found that organizations appeared to have adopted similar outsourcing practices under institutional pressures. However, whether or not an organization could successfully implement an outsourcing decision depends on the organization’s IT capabilities, governance capabilities, and capabilities to manage its relationship with the vendor. Research implications of these results are discussed.