One of the more trenchant criticisms made of the work of Organisation Development practitioners is that they are really “organisational social workers”, relatively impotent in terms of strategic decision‐making within the enterprise and best employed in providing “tea and sympathy” to shell‐shocked victims on the corporate battlefield. In this role they can bring to bear their panoply of techniques (counselling, life planning, assertiveness training, etc) to ameliorate the ravages of organisational life. Happily, there is now some evidence of the unhappiness of many OD practitioners with this role and consequent attempts to move into the areas of strategy and planning. This article recounts the process by which a unit of practitioners in the British National Health Service moved over a four‐year period from a concern with the casualties of large‐scale organisational change to involvement in questions of organisation design.