In this paper we discuss the challenges of managing large-scale information infrastructures. Various

management models, such as the IT governance model, propose structured approaches for

management of an organization’s infrastructure. This paper argues both theoretically and empirically

that such an approach to information infrastructure governance has its limitations. The paper is based

on empirical material from three change processes in information infrastructures in the context of

health care. We present case vignettes that illustrate how these processes evolved along unexpected

trajectories, subject to factors beyond the control of management. To conceptualize these phenomena

we draw on literature that conceptualize change as emerging from the meeting between multiple

parallel streams of activities. The interactions between the various streams open up windows of

opportunities that affect the information infrastructure development. We argue that such

conceptualizations more realistically depict how large-scale information infrastructures evolve, and

hence how they can be (or not be) managed.