This research takes steps towards developing a new theory of organizational information management based on the ideas that, first, information creates ordering effects in transactions and, second, that there are multiple centers of authority in organizations. The rationale for developing this theory is the empirical observation that hospitals have great difficulty in managing information relating to transactions with patients. The research illustrates the detailed workings of an initial conceptual framework based on an action research project into the revenue cycle of a hospital. The framework facilitates a deeper understanding of how information technology can help to transform information management practices in complex organizations, such as hospitals. At the same time, this research adds to the literature on Polycentricity Theory by linking its two core concepts—multiple nested centers of decision making and context-dependent governance—with Transaction Cost Theory and information management theories to establish a new foundation for understanding the role of information technology in organizational contexts.