The board functions at one of the interfaces between the environment and the organization and must take account of competing external and internal discourses. This article explores the institutionalizing activity manifest in the written organizational texts of board meetings of Local Health Boards in Wales. The focus of attention is how the localized discourse (1000 Lives) of an international, industry level, institution (Patient Safety), contributes to institutionalization and deinstitutionalization as recorded in the minutes of the board meetings. The conclusion is that as the boards develop and record their emerging discourse they construct and reconstruct the social reality of their organization. The organizations are composed of fragmented and competing discourses with no finality to meaning making, and continual conflict among multiple meanings looking for interpretive control, which the board [re]arranges into a seemingly coherent, unified, and meaningful discourse.
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