The paper explores how complex organizational change processes can be succesfully handled. The fundamental challenge is to unfold the operative paradox which systematically emerges in the contradiction of current and future organizing. The paper is based on a longitudinal, single case study in a Swiss acute hospital over a period of eight years. Taking a system theoretical perspective, we identified six interrelated communicative practices to handle the paradox within the organization. These practices point to "structuring communication" as the relating principle to handle the two opposing poles involved in paradoxes of changing.