In order to meet the needs of their multiple stakeholders, public sector organizations are increasingly asked to improve the efficiency and quality of their services. With this respect, the implementation of innovations has been advocated as a means to accomplish this challenging task. Empirical evidence reveals, however, that organizations frequently struggle to implement innovations or fail to achieve the intended benefits of adopted innovations. Despite widespread interest in this issue, the literature does not provide convincing explanations as to why this occurs, with implementation processes largely treated as a ‘black box' in existing research. This article addresses this research gap by analyzing the underlying dynamics that shape implementation activities. A multiple case study design is used to research into the implementation of a process innovation in five public hospitals. The findings show substantial differences between the cases in regard to implementation success which can be attributed to idiosyncratic process dynamics.
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