Planning to innovate. Designing change or caught up in a game?

In this article I engage with some orthodox theories of the management of innovation and change, which take for granted the idea that they can be predicted and controlled. Organizations are thought to be systems with boundaries, which managers acting as engineers, or doctors, can 'diagnose' and restore to 'health', or order differently. As an alternative, and by drawing on an experience of working with health service managers, I argue instead that change and innovation arise as a result of the interweaving of everyone's intentions. Organizations are sites of intense political interaction and contestation, and exactly what emerges is unpredictable and unplannable, even by the most powerful individuals and groups.