Purpose - The purpose of this paper is to identify middle managers' strategies during changed accounting conditions. Design/methodology/approach - Middle managers from hospitals, primary care and community care were interviewed about their strategies during change processes. Each middle manager selected changes that had played the greatest part in a ten-year period. Findings - Each change was dominated by one strategy that corresponded to the tactics of middle managers during change. They ITquestioned/IT new control models, they ITexperimented/IT with smart budget strategies and they ITimplemented/IT new IT technology. These strategies formed transitions in a continuous circular change model based on Hinings and Malholtra. The study points to two key findings. First, strategies that can be perceived as irrational are organised within a context of plausible explanations; and second, middle managers in public organisations are likely to adopt innovations supported by management policy voluntarily and to question or even reject those prohibited. Research limitations/implications - Criticism may be directed towards the fact that the theoretical model presented in the analysis has an element of determinism. In the model, the managers' control strategies are given limited influence. The theoretical model's strength is that it measures the development in slow-to-change public organisations with long histories and deeply rooted practices. Practical implications - The results can be used to understand the motives of the middle managers' strategies for change. It provides support to management that hesitates between defending a well-established but criticised organisational model, and implementing new and untested approaches. Originality/value - Theoretical change models frequently originate from a management perspective or differentiate between "top-down" and "bottom up" change. In this paper, change is regarded as a generalised process where different phenomena are connected. This forms a circular model that moves between stable phases without change and transformative phases of major change. © 2012 Emerald Group Publishing Limited. All rights reserved.