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Much of the change that social movements try to accomplish requires changing practices inside organizations, yet reform implementation is difficult to achieve. This comparative case study of two hospitals demonstrates that implementing reform inside organizations may require internal reformers not only to mobilize with one another but also to stand up to internal defenders' countertactics in everyday encounters. Because reformer alliances across identity lines often require reformers with different statuses to collaborate with one another, defenders can divide reformer coalitions by linking reform practices to a status characteristic associated with lower-status reformers, denigrating higher-status reformers by associating them with these practices, and reintegrating higher-status reformers into the defender group. When status threat inside an organization is high to begin with, higher-status reformers are likely to be concerned about loss of privilege in the face of defenders' status-based countertactics and, in response, distance themselves from reform practices and align themselves with defenders to protect their identity and its rewards. This can undermine the multi-identity reformer coalition and cause change to fail. These findings regarding status-based countertactics contribute to our understanding of social movement implementation and microinstitutional change

Making the Cut: Using Status-Based Countertactics to Block Social Movement Implementation and Microinstitutional Change in Surgery