The focus of this paper is on how organizational change within medical research evolves and is influenced by different types of institutions at different geographical levels, as well as what characteristics of the key individuals are important in enacting institutional opportunities and overcoming hindrances. The paper reveals the complexity of institutions influencing change processes. First, the relations between institutions can be complementary, reinforcing or contradicting, suggesting that individuals initiating change should consider possible responses to institutions contradictory to the initial opportunities, as well as take advantage of reinforcing and complementary norms, rules, and procedures. Second, although different types and levels of institutions have a joint impact on change processes, some institutions are more prominent than others in different phases of the process. Individuals can take advantage of institutional opportunities and overcome hindrances due to their personal qualities and position in the organization.
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