Aim

To develop a deeper understanding of health‐care managers' views on and approaches to the implementation of models for improving care processes.

Background

In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome.

Method

In‐depth interviews with first‐ and second‐line managers in Swedish hospitals were conducted and analysed using grounded theory.

Results

‘Coaching for participation’ emerged as a central theme for managers in handling top–down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work.

Conclusion and implications for nursing management

Implementation models for improving care processes require a coaching leadership built on close manager–employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process‐oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.