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AbstractIn this article, we present a case of institutional development in a Quebec health care center. Drawing on a qualitative and constructivist approach, we show that an institution can undergo change while maintaining its institutional nature. The strategic changes studied lead us to consider two factors needed to succeed in an institutional change. Firstly, through a specific pattern the social worlds in the hospital are mobilized according to their relative importance. Secondly, the organizational actors must draw upon their strategic and professional competence to make changes compatible with the values embodied within their institution. These factors illustrate the role of actors in institutional change. Copyright © 2010 ASAC. Published by John Wiley & Sons, Ltd.