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

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.

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

‘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 …