Summary Based on the merger of two Swedish university hospitals, this paper examines top management's work in implementing radical change initiatives. Our case confirms the limitations of the classic top-down approach to radical change in professional organizations. We also identify an important paradox: contrary to contemporary change literature prescription, initial managerial success seems to impair the change process further down the organization. A key finding is that when mergers are used as tools to effect radical change in politically ambiguous environment, management appears to be limited to initiate change and to take the role of the scapegoat due to inherent factors in the change process. By elucidating management's difficult role vis-à-vis multiple stakeholders, this paper contributes to one aspect of managerial agency discourse that is rarely discussed in detail.