From emergence to recoverability: a sociotechnical control trajectory theory of HIT-related risk

Health information technology (HIT) is deeply embedded in contemporary clinical practice, yet incident-based research continues to show that digital systems can introduce new and sometimes widespread risks to patient safety. While prior studies have been effective in classifying types of HIT-related problems, they offer limited explanation of how such risks emerge, remain unnoticed, spread across sociotechnical systems, and ultimately lead to harm-or are successfully contained. This article advances the Sociotechnical Control Trajectory Theory, a theory-forward framework that conceptualises HIT-related risk as a dynamic process of control degradation and recovery within routine clinical practice. Rather than treating HIT incidents as isolated events or static failures, the theory explains how risk evolves over time through interactions between digital systems, clinical workflows, and organisational responses. The framework specifies four recurring phases, i.e., risk emergence, risk hiddenness, risk propagation, and recoverability or loss of control, and identifies four cross-cutting control capacities that shape outcomes at every phase: observability, interpretability, coordinated response, and system margin. The contribution of the framework lies in integrating existing sociotechnical, resilience, and systems-control perspectives into a temporally structured explanatory model specifically focused on the evolution of HIT-related risk within digitally interconnected clinical environments. To support empirical application, the article derives a set of testable propositions and proposes indirect sociotechnical indicators that may facilitate earlier recognition of emerging control degradation through incident reports, system logs, ethnographic methods, and mixed-methods designs. By shifting attention from post hoc incident description to the dynamic mechanisms through which HIT-related risks develop and unfold, the Sociotechnical Control Trajectory Theory provides a foundation for more proactive safety monitoring, system design, and organisational governance in increasingly complex digital health environments.