This study seeks to explain how stakeholders' dynamics influence Information and Communication Technology (ICT) strategic projects implementation in Saudi Arabian public hospitals. Stakeholder theory, mainly the identification framework of Mitchell, Agle, and Wood, is used to identify stakeholders' saliency throughout the project events. However, stakeholder theory is static and do not help in tracking dynamics, i.e. how saliency is gained and lost through the events, and hence interpreting the influence. Therefore, this research challenges this staticity by instrumentally using appreciative systems concepts of Vickers and the later operationalized model developed by Checkland and Casar. Appreciative systems might help in tracking dynamics and interpreting their influence on ICT strategic project reality. Results show that stakeholder saliency dynamics reside in continual appreciative processes. Such dynamics directly exert an influence on the ICT project, which is strategic, i.e. significant changes to direction, emphasis and resources. Theoretical insights from this study have also practical implications.