Mega projects are characterized by lengthy and complex decision-making processes with a high degree of ambiguity and uncertainty. Moreover, the impacts of mega projects are far-reaching and influence millions of people. Because of their transformative character, the front-end decision-making phase of such huge projects functions as a magnet of dreams and visions from of variety of policy-entrepreneurs. Yet, few studies have studied the agenda setting phases of mega projects through the multiple streams framework. Based on an in-depth case study of a Swedish mega project, the ‘New Karolinska’ hospital in Stockholm, this paper demonstrates how the organization of the front-end decision-making process is used as a key strategy for policy entrepreneurs to couple highly transformative policy solutions to existing policy problems. The New Karolinska project was initiated in 2001 and has recently resulted in the construction of a new, top modern and extremely costly university hospital in the city center of Stockholm. The project has from the start encompassed controversies, extra-ordinary organizational solutions as well as public media scandals. The theoretical implications of this study for the MSF are several. First, it provides new insights about the conditions under which radically transformative ideas succeed in the agenda setting processes. Secondly, it forefronts the organizational dimensions of policy entrepreneurs’ strategical toolbox. Thirdly, it adds to the growing body of research that applies and develops the MSF to agenda setting processes on sub-national levels in multi-party parliamentary systems.
