Abstract
This article discusses how change occurs within a highly specialized hospital. Using an interactionist approach, this study observed and analyzed two complex care processes, one in surgery and one in medicine. In each significant changes were observed at the clinical practice level. The study was conducted over a five-year period in a regional hospital. Three conclusions emerged from the study: 1. Certain characteristics in exchange relations were present that rendered the transformation of clinical practices difficult. 2. However, it was demonstrated that it is possible to introduce change by subduing dominant characteristics. 3. The role of confidence was emphasized in any change dynamic.
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