This research examines how the first organizations to abandon an institutionalized, taken-for-granted structure and adopt a radically different form presented the innovation to important stakeholders. A content analysis of hospitals' annual reports reveals that organizations that differed on other dimensions uniformly made preventive use of defensive impression management in announcing the change to a diversified corporate structure. The organizations invoked coercive and mimetic pressures to account for and justify the new structure, and they associated the innovation with legitimated organizational activities. The findings make two contributions that link the “old” institutionalism and neoinstitutionalism: they point to organizational agency in the preventive use of the very institutional forces that create isomorphism and suggest the presence of institutional forces even during the early stages of innovation.
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