The UK National Health Service is experiencing enormous growth in the deployment of information and communications technologies (ICTs). Extensive use of technology serves to ‘reconfigure the organisation’ through its application in data analysis, communication and decision support. This paper reports some preliminary findings from an ethnographic study of hospital information systems in everyday use, documenting precisely how people, systems and enterprises interact and collaborate. Our paper reports on some of the complexities involved in the use of ICTs in everyday managerial work and documents the articulation in practice of the cultural, organisational and technical arrangements through the investigation of the ‘hands on’ work of Hospital Trust management.