This paper discusses the theoretical rationale for an empirical study of organisational change arising from introduction of electronic nursing documentation in residential aged care facilities. The study draws on a processual view of organisational change, which is related to the theory of complex adaptive systems. First we review existing literature on electronic nursing documentation with an organisational focus to provide a context to help outline the research aims of the present study. Then we describe a method to explore the hierarchical nature of the work environment based on the sociological theory of Institutional Ethnography. Finally we use this approach to describe the differences in initial conditions between two different sites implementing the same software over the same timeframe. Results suggest that our method is sensitive enough to detect subtle but substantial differences in initial conditions between the two study sites.