This is a comparative case study of public sector hospital mergers in England and Ontario in the 1990s. Its purpose is to explore how change evolved and the organisational consequences as the hospitals underwent restructuring. The main focus is on the consultation process prior to the decision to merge. The objectives of this work were to analyse the interaction of government agencies and key stakeholders (as defined) in the period leading up to the merger and to track the restructuring process to determine if a new organisational form emerged. Multiple sources of data were collected and collectively the data spanned 19 years for both cases. The researcher conducted 79 interviews in 24 different hospitals and health care organisations over a period of 5 years. The researcher draws on archetype theory and Neil Fligstein's work on power and the social skill of actors to construct a framework for analysis. Archetype theory focuses on intra-organisational dynamics of change and is useful for analysing the emergence of new or hybrid organisational archetypes, but does not focus on the role of external power and politics in the change process. Fligstein's work emphasises the importance of power and how actors may induce co-operation in others to influence and manipulate the change process. The results of this research show that in similar market contexts there were significant differences (in the pre-merger review and consultation processes and in the organisational outcomes) between change that was 'stakeholder-led' and change that was led by government agencies. These merger types can be distinguished in terms of three distinct but closely related factors: the government's approach to consultation with stakeholders; the power dynamics and interaction between key stakeholders during both the consultation process and the post-merger restructuring process; and the extent of manipulation of any of those processes by government agencies.