PurposeIn accounting literature, there is a strand of thought that is founded on the old institutional economics. One of the problems is that institutional theory can demonstrate resistance to change, not the formation of change. The purpose of this paper is to contribute to theory formation, in particular to enrich the institutional framework for understanding change, by showing how medical specialists in hospitals, in particular urologists, shape change processes in organizations as reflected in behavioral routines. The results will also contribute to the empirical understanding of medical specialists' behavior. This could generate dynamic accounts of organizational change and help to find a way towards an enhanced framework.Design/methodology/approachIn Dutch hospitals a new management control tool is implemented, which is the diagnose treatment combinations (DTC) system. A DTC is a way to describe the required medical procedures for a specific illness in a hospital. Here, an investigation is carried out on how and if the behavior of medical specialists changes because of this introduction.FindingsAfter analyzing interviews with urologists, four common themes are distinguished and scripted behavior is described. The individual tracks in scripts can be distinguished, but there is more. This is the story that gives coherence to the various behaviors and shows how the arrangement of behavioral routines in an organizational context forms organizational change through time.Research limitations/implicationsThis research was based on the institutional perspective. Another view on management control would emphasize other aspects of behavior. In addition, this was only based on one specialism in three hospitals, so generalizability of the results will be low.Practical implicationsThe results contribute to empirical understanding of medical specialists' behavior.Originality/valueThe results will contribute to the empirical understanding of medical specialists' behavior and it will contribute to theory formation in management control literature, in particular by enriching the institutional framework for understanding change.
