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Purpose– The performative approach views organizational routines as generative systems with internal aspects – ostensive and performative – and dynamics (Feldman and Pentland, 2003). The purpose of this paper is to better understand under which conditions the routine dynamics happens or not.Design/methodology/approach– To deal with this issue, for 13 months, the authors conducted a comparative and longitudinal case studies based on the evolution of the organizational routines in absence management in two departments of a French hospital.Findings– The results show contrasting dynamics in the studied organizational routines: one evolved, the other in contrast, seemed blocked. The authors suggest that the routine dynamics depends on the relative weight of its ostensive and performative aspects: a balance situation makes mutual adaptions possible and an imbalance situation leads to the conservation of defective routine. The research underlines also that, in the hospital context, the capacity of management and teams to discuss and to negotiate the implementation of external rules plays an important role in the balance of the internal dimensions of routine.Originality/value– While the literature on performative approach focusses on the “how and why” the routine act as a source of continuous change, this research investigates more in depth the working of the routines dynamics itself. The issue of balance or imbalance introduces a new element in the framework of routine dynamics and can constitute an interesting focus for managers looking to transform their organizational routines.