Pied Pipers and Followers: Interorganisational Alignment in a Health Information System Implementation

In the public sector, projects are one of the main mechanisms of implementing strategies and that is evident in healthcare. Extant studies of health information systems (IS) implementations find that IS alignment enables organisations to meet their strategic objectives; conversely, misalignment can lead to unintended, and often adverse, results such as the abandonment of health IS projects. Studies attribute misalignments to strategic drift, which we find more likely in pluralistic settings given multiple parties, with potentially competing goals and interests, attempt to implement a shared strategy. This study contributes to extant literature by exploring IS alignment as a dynamic process in the context of a 20-year health IS implementation involving multiple organisations from government, public, and private sector. The question we aim to address for governments, developers, and implementers - how do we collectively move beyond the short-lived success of projects to achieve the envisioned strategic benefits of health IS