This article describes how the alignment of business and information technology (IT) strategies impact organisational performance. The alignment involves an entire organisation. However, much of the research has focused on the factors affecting alignment at the senior executive level, and there appears to be less attention placed upon factors that affect the lower operational levels. This article attempts to address this gap in the literature through a case study of a healthcare organisation. Semi-structured interviews with ten employees at an operational level were qualitatively analysed to elucidate factors. Organisational culture, management expectations, communication, and the provision and recognition of skills were identified as main factors that may affect the alignment of business and IT strategies at the lower levels.