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Understanding how and why organizational changes succeed is of paramount importance because many organizational changes do not deliver the expected results. This paper presents a case study of successful change at a world leading cardiology department and proposes a model of cascading change that requires change managers to go beyond the simplistic dichotomies of planned versus emergent change. Successful change requires the reconciliation and integration of top-down and bottom-up approaches. Top management must set the direction and should then step back and allow the diagnosis and solution-development processes to take place in a bottom-up manner. This allows employees to identify and solve the problems that matter to them and that reflect their organizational reality. The implementation of the changes toward the end of the change process should take place in a top-down manner. The cascading model of change is based on three key drivers: a cascading change process with formal handovers engaging more and more employees, Lewinian change processes of unfreeze, move, and refreeze, and, finally, orchestrated employee participation. The cascading change process is found to build participation, transparency, trust, and commitment to the change among employees and managers. In turn, this ensures that implementation occurs without problems.

The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.