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State intervention, such as school turnaround, has been shown to sometimes improve school performance. Yet, there is a question about the mechanisms by which states create the needed conditions to change school institutions. The results from this multi-method longitudinal study suggest turnaround technical assistance relies on a multi-stage process involving different forms of institutional work. However, turnaround technical assistance staff more frequently focuses on institutional work creating new beliefs, practices, and structures rather than disrupting old ones that may be inappropriate, ineffective, or even harmful. One implication is the importance of attending more closely to variations in the forms and frequency of institutional work involved in turnaround and to the potential impact of this variation on school improvement outcomes.