This paper highlights the use of structuration theory in explaining information systems development and use in a UK public National Health Service (NHS) organization. Our aim is to apply structuration theory to understand the social aspects of such a process. In the research presented below, we describe: (1) the ‘hidden’ aims of an information systems project, (2) the importance for a successful project of maintaining legitimation and domination structures which reflect a close and synergistic relationship between top and project management, (3) how consequences of information systems use, both intended and unintended, act to shape attitudes and structures, which will, in turn, shape behaviour in different ways.