Renegotiating HRM Practices and Delivering Service Transformation of Frontline Workers: Insights from the UK’s NHS Ambulance Trust During a Significant Disruption.

We note that while the institutional environment determines the actions and structures of constituent organizations, there are still limited insights available in the literature on the nature and process of interactions between key stakeholders in ambulance services, especially as they respond during a significant crisis. This study specifically examines how a positive social exchange between senior leadership, managers, and frontline staff, accompanied by changes to the leadership style and HR practices, resulted in significant service transformation. An in‐depth qualitative case study design was used to interview 52 frontline staff and leaders from the UK National Health Service's (NHS) Ambulance Service over a prolonged period of 8 months (October 2020 to May 2021). Interviews and secondary data were abductively analyzed, showing how changes to HRM and leadership practices shaped service transformation's content, process, and logic. The findings suggest that an iterative social exchange between the key social actors in the Ambulance Trust led to adaptations to the nature of HRM and leadership practices, which positively impacted the changes to service delivery, leading to service transformation and improved health and well‐being of paramedics. Our conceptual framework contributes to the literature by integrating how the use of agency, new HRM, and leadership practices in the context of institutionalized structures can result in service transformation. Implications for theory and practice are also discussed.