We argue that our understanding of practice adoption has been limited by the prevailing view that variations in adoption stem from consciously made decisions. We counter this position by arguing that a key, and neglected, aspect of the adoption process concerns understanding the level of conscious engagement of those involved. In so doing, we theorize that there are two distinct institutional dimensions necessary for understanding how practice adoption takes place: acceptance and implementation. We develop these dimensions to provide a framework showing that different within-organization responses will be associated with differing levels of acceptance of the need to adopt a practice, the acceptance dimension, and differing levels of conscious reflection during implementation of the practice, the implementation dimension. We then unpack this framework to explain how variations in discourse play a determining role in how practice adoption unfolds. This reveals an interesting institutional paradox: the discursive characteristics that make a practice more easily accepted also reduce the conscious engagement needed for its implementation. The balance of the paper is spent developing the implications of our theorizing for understanding the process of practice adoption.