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The accomplishment of significant organizational or technological change in health care institutions rests on an understanding of the Social forces in those institutions which affect the timing and degree of acceptance of change. The important factors which characterize health institutions, such as fragmented power and competitiveness, along with specialization and allegiances to external organizations and groups which characterize health institutions are described. Case examples are cited which illustrate how social and interpersonal factors can dominate decision-making processes related to organizational and technological change. This paper describes decision making as basically a political process. Some suggestions are put forth to aid those persons who are concerned with effecting change in health care institutions.