AbstractThe aim of this study is to understand and explain how street‐level bureaucrats manage high workloads in public healthcare organisations. Data was collected through observations, interviews and documents. The results show that high workloads are reduced through use of collegial mechanisms at the organisation level. The study shows that workloads are reduced in a two‐step process, the first is a negotiation between professionals and the second in the meeting with patients. The two‐step process explains the limitation problems in more detail and makes an important contribution by explaining how high workloads are reduced in public health services.