Navigating multiple contexts to integrate system transformation programs

•System transformation programs need to be integrated into multiple organizational, interorganizational and system-level contexts.•Such contexts may have conflicting demands for integration.•An iterative pattern of context navigation practices was found in a multiparty healthcare transformation program: aligning contexts, prioritizing contexts and adding previously uninvolved, “new” contexts.•The pattern shows a fanning out of the program through multiple parallel collaborative paths, which enabled progress and integration with multiple organizations.•Breakdowns and decoupled collaborative paths add novel understanding to the management of transformation programs in relation to the multiple contexts they take place in.