In this article, the concept of effectuation is introduced to address the question of how innovations in health service organisations arise, in what circumstances, and what mix of factors tends to produce adoptable innovations. Our case study investigates an ongoing initiative to introduce patient-oriented web-based services in hospital settings. In the analysis of the case we point to the relation between the technologies employed and the tactics identified. Our analysis emphasises (1) the role of thinking in terms of affordable losses, (2) the role of alliance building (3) the role of flexible web-based technologies. Building on these core aspects we thematise frugal approaches to novelty and we propose that the concept of effectuation can be useful for exploring change dynamics that transcend the organic/planned and grassroots/top-down divides.