Purpose: Existing research on the organizational implications of the introduction of new information technology (IT) has neglected to focus on the anticipation of organizational change. In this paper, the author examines the extended pre-implementation phase prior to the introduction of the largest-ever health IT (HIT) implementation in Denmark. The purpose of this paper is to expand the conceptualization of organizational change to include the neglected pre-implementation phase preceding large-scale organizational change projects. Design/methodology/approach: The research is based on qualitative data consisting of interviews, documents and observations gathered during a three-year research project in the Danish health sector. An important source of methodical inspiration has been grounded theory, which has allowed the pertinent interview themes to evolve and allowed for the gradual development of a theoretical framework. Findings: The main finding of this paper is that the anticipatory pre-implementation phase is not simply passive waiting time for organizational members. Evidence from a three-year research project demonstrates how organizational members engage in recurring patterns of sensemaking, positioning and scripting of possible futures in preparation for the organizational changes that next generation HIT imposes. The study argues that resistance to organizational change may be better understood as resistance to having to give up institutionalized rights and responsibilities. Originality/value: The paper offers a conceptual model—the anticipation cycle—that enables the systematic analysis of the relational mechanisms at work when organizational members are preparing for pending organizational change. Early analysis based on the anticipation cycle enables organizations and scholars to bring previously black-boxed anticipatory patterns into the equation of organizational change.