Aims: To explore and describe the impact of the organizational culture on and the patient–practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway. Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners’ performance. Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework. Methods: Participant observation and informal interviews (92 hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April–November 2015. Data include 261 interactions between patients, aged ≥18 years seeking care for AAP at the ED and admitted to a surgical ward (N = 31; aged 20–90 years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N = 198). Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics. Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.