Purpose - The purpose of this paper is threefold: to describe how a large organization has successfully worked to achieve sustainable health, compare the work of the large organization with methodologies used by smaller successful organizations, and then to create a model for how managers of larger organizations can work to create sustainable health. Design/methodology/approach - The empirical data were gathered through interviews with managers at different organizational levels and workshops with employees, within a case study in a large bank which received the award "Sweden's best workplace". The data were also compared to results from earlier case studies of three smaller organizations that have received the same award. Findings - The results of the studies show coinciding results as to the importance of management commitment and methodologies, such as employee involvement, delegation, goal deployment and coaching, to create a health-promoting work environment. This indicates that larger organizations do not need any specific methodologies. Practical implications - Based on the experiences from four successful organizations, managers should mainly consider doing the following: start measuring and evaluating the consequences of sickness absence in their organization, and adopt a management strategy based on humanistic core values that are supported by methodologies and tools. Originality/value - The paper adds understanding about how managers of large organizations could work practically to overcome management problems in today's working life and support the work and organizational factors earlier described in the literature to create a health-promoting work environment that stimulates the development of sustainable health. © Emerald Group Publishing Limited.