When innovation fails

We combine the concepts of legitimacy, institutional (mis)alignments, strategic responses and organizing visions to develop a conceptual framework to analyze the adoption of innovations that span organizational fields. We apply this framework to examine a telehealth innovation connecting a public sector hospital-based Eye Clinic with private sector optometry practices. We find that while compromise strategies were successful in encouraging adoption within each field, the innovation ultimately failed because the fields developed different organizing visions that could not be reconciled. The findings suggest that institutional misalignments within and between fields interact to amplify their overall effect on the adoption of hybrid innovations.