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Purpose: While previous research acknowledges the influence of roles on routine dynamics, roles are largely taken for granted. The purpose of this paper aims at examining how roles and routines interplay in accomplishing work in organizations.

Design/methodology/approach: A four-year ethnography of an emergency department (ED) at a university hospital was conducted through observations, interviews and documents.

Findings: Roles and routines are formed by scripted and unscripted patterns, which are brought into performances following a situational assessment. Performances trigger patterning processes prompting the co-construction of role and routine patterns.

Practical implications: This study highlights the importance of designing flexible structures. Managers can benefit from identifying unscripted patterns critical to work performance and making them part of scripted patterns. Managers should contemplate the influence that individuals, their relations and context have on how work is done.

Social implications: This study suggests that the existence of different patterns impacts the length of wait times in EDs, a societal issue worldwide because of the effects that waiting can have on the patient's health condition and the unnecessary costs it carries. This study can help design solutions to decrease wait times.

Originality/value: This paper contributes to research on routine dynamics by providing a more nuanced explanation of the sources of endogenous change and how these enable organizational stability and flexibility.