Abstract

This mixed-methods case study describes the experiences of a rural health organization in Canada that was a pioneer in undergoing institutionally driven radical change. This change was advocated by senior managers and physicians with the strong backing of the government. The senior managers and physicians made a strong case for the radical change and argued that a focus on efficiency and wellness would lead to improved service and quality of patient-care. However, this radical change initiative was resisted by nurses and support staff who perceived that these changes were being driven by market-based institutional logics and questioned their ethical appropriateness in a public system. They also expressed a lack of trust given the large-scale layoffs in a prior restructuring. These findings run counter to extant theory by highlighting the role of agency despite institutional pressures. Specifically, change implementers not only face the burden of justifying ethical appropriateness of institutional logics, but also are required to engage in persuasive discourse that these institutional logics protect the interests of the members.