Purpose: Contingency and institutional theories of organizational development are used to describe and interpret the 100-year history of a health science university and to then make a case for teaching organizational sociology in administrative preparation programs. Design/methodology/approach: Primary and secondary documents were analyzed to delineate the university's history. Findings: Results indicated that organizational development was the result of complex institutional commitments that were challenged by and reinterpreted in the face of controversial and unanticipated contingencies. Both contingency and institutional theories help explain organizational processes. Organizational sense-making theories from Karl Weick explain conflicting findings related to the tensions between old and new, the known and unknown, and the set and novel environmental and organizational processes. Research limitations/implications: This research shows the usefulness of organizational theory in helping administrators develop more elaborate ways of thinking about their schools. The process of theory crafting and testing encourages essential openness and curiosity in administrators. Practical implications: Administrative candidates should be introduced to the content and processes of organizational sociology as a way of thinking about their leadership and organizational processes. Originality/value: Organizational theory, including organizational sociology, contingency theory, institutional theory, and sense-making remain viable in the study of educational organizations and can provide new administrators with a guide for their own meaning construction.