The dynamics of IT-business strategic alignment: evidence from healthcare information systems implementation Xiqing Sha School of Economics and Management, Southeast University, Nanjing, China Jing (Elaine) Chen School of Economics and Management, Beihang University, Beijing, China and Key Lab of Complex System Analysis and Management Decision, Ministry of Education, Beijing, China, and Say Yen Teoh School of Business IT and Logistics, RMIT University, Melbourne, Australia Abstract Purpose – This study intends to reveal how to manage the dynamic process of information technology business (IT-business) strategic alignment; managing this alignment is an unknown yet critical issue that must be addressed by any firm trying to unleash the business value of their IT investments. Design/methodology/approach – This study presents our case study of a healthcare organization after healthcare information systems (HIS) implementation and investigates the strategic alignment between the implemented HIS and the organizational strategy from a dynamic perspective. Findings – Two different patterns of alignment (i.e. an IT-strategy–driven pattern and a business-strategy– driven pattern) are identified, and a process model of the IT-business strategic alignment is developed. Moreover, this study focuses on the social dimension of strategic alignment and examines the role of this dimension, which is critical and fundamental with respect to other dimensions, in achieving strategic alignment. Research limitations/implications – This paper makes important theoretical contributions to the understanding of strategic alignment by taking a dynamic view of alignment, identifying different patterns of alignment, emphasizing the role of social alignment and developing a comprehensive process model. Practical implications – From a managerial perspective, managers should periodically scrutinize the IT- business alignment patterns of their organizations and develop dynamic capabilities for strategic alignment. Originality/value – While most of the literature on the dynamics of strategic alignment have focused on confirming the dynamics of strategic alignment and identifying the factors that create dynamics in alignment, this study examines IT-business alignment as a continuous process over time, thus providing a novel perspective. Moreover, while the role of social alignment and its impact on downstream performance remain unclear in the current literature, this study incorporates the social dimension of alignment to investigate the role of this dimension in achieving IT-business strategic alignment. Keywords Strategic alignment, IT-business alignment, Healthcare information systems, Implementation, Management practices, Case study Paper type Case study 1. Introduction The strategic alignment between business and information technology (IT) has been a top managerial concern for both information systems (IS) practitioners and researchers because this alignment allows firms to better unleash the value of IT investments and, consequently, Dynamics of IT-business strategic alignment This research is supported by China’s NSFC (71502031, 71802017, 71531004) and the Fundamental Research Funds for the Central Universities –Jiangsu Off-Campus Research Base for Humanities and Social Sciences (No. 2017ZSJD001). The current issue and full text archive of this journal is available on Emerald Insight at: https://www.emerald.com/insight/0959-3845.htm Received 20 August 2019 Revised 8 April 2020 24 June 2020 Accepted 13 July 2020 Information Technology & People © Emerald Publishing Limited 0959-3845 DOI 10.1108/ITP-08-2019-0414