Purpose – The purpose of this paper is to adapt a causal modelling approach to investigate the organisational collaboration and information technology (IT) project management issues concerning the planning and adoption of inter-organisational IT systems across NHS hospital pathology departments. Design/methodology/approach – The researchers adopted an interpretive research approach utilising qualitative methods and in particular template analysis. Themes and categories were initially derived from a review of the literature based on critical success factors from enterprise resource planning (ERP) projects. Findings – A causal loop modelling approach was adapted to define key linkages between success factors. This highlighted virtuous and vicious cycles associated with IT project management and team collaboration – influencing the adoption process of large-scale integrated IT systems. Research limitations/implications – Single case studies can be problematic in terms of generalising from the research. The study had a limited number of interview participants due to the focus on strategic management. Future studies could extend the number of stakeholders involved and also focus on end-users of services, such as clinicians in primary care. Practical implications – The discussion and conclusions assess the appropriateness and utility of using a causal modelling approach, and an adapted causal loop model, to inform more effective approaches to IT planning, project management, team collaboration and adoption of integrated systems. Social implications – The findings indicate that a more enhanced understanding of project team collaboration involving technical, administrative and clinical stakeholders has the potential to inform more effective strategies for modernisation of hospital clinical services such as pathology. Originality/value – This study investigates the anatomy of a high-profile IT project under the umbrella of strategic modernisation of health services. Privileged access to key stakeholders has enabled the development of a causal model for IT project collaboration and management. This will form the basis for further development of more refined models to enhance project outcomes in the future.