Geiger, SusiSusiGeigerStendahl, EmmaEmmaStendahl2023-11-242023-11-242023 The A2024-09Journal of Management Studies0022-2380http://hdl.handle.net/10197/25031This article explores how heterogeneous and distributed forms of social-symbolic work combine over time to yield synergistic relationships that precipitate institutional change. We study a collective effort by patient activists to change the technological and regulatory standards of Type-1 diabetes care. We offer contributions to radical flank theory by conceptualizing radical and moderate flanks as dynamic and overlapping pathways of action rather than fixed actor positions, and we show how a medial ‘bonding’ pathway can provide important social glue to connect the radical and moderate flanks. While in our case the material and discursive ‘hacking’ work in the breaching pathway disrupted institutions, triggered technology innovation, and created momentum for change, material and relational ‘bridging’ embedded these efforts into existing institutional structures and longer-term innovation trajectories. Values and amplification work in the bonding pathway served to keep the two other pathways aligned over time. By addressing how a complex social problem – patient-centric innovation - may be affected through heterogeneous social-symbolic work that leads to institutional accommodation, our study holds considerable policy and societal relevance.enThis is the peer reviewed version of the following article: Geiger, S. and Stendahl, E. (2023), Breaching, Bridging, and Bonding: Interweaving Pathways of Social-Symbolic Work in a Flanked Healthcare Movement. Journal of Management Studies, which has been published in final form at https://doi.org/10.1111/joms.12979. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.Institutional changeMaterial workPatient entrepreneurshipRadical flank theorySocial movementsSocial- symbolic workJournal Article6162501253410.1111/joms.129792023-06-27771217https://creativecommons.org/licenses/by-nc-nd/3.0/ie/