The objective of this paper is to analyze the development of dynamic capabilities in the process of hospital accreditation, using case study methodology. Data were collected through semistructured interviews, observation and document analysis and analyzed through content analysis techniques. We found that deliberate learning and relationships were the principal sources for capability creation, and that they were renewed and recombined along the way. Periods of convergence punctuated by strategic reorientation allowed us to conclude that the changes adhered to the punctuated equilibrium model. The outcomes of this study advance the findings documented in the literature about the construction of a formative path of dynamic capabilities, understanding the duality of operational and dynamic capabilities, and comprehending the mechanisms by which capabilities are developed.