As a pivotal component of the governance system for medical damage liability disputes, the institutional construction of medical malpractice evaluation exerts a far-reaching influence on the high-efficiency governance in the medical field. Therefore, this study systematically examines two developmental phases that medical malpractice evaluation has undergone since the 21st century from the perspective of institutional change theory, namely the dual-track operation phase and the dual-track integration phase. It conducts an in-depth analysis of local governance patterns and their practical dilemmas within the context of phased institutional paradigms. This study further offers theoretical interpretations and changes management analysis on this institutional transition. The purpose is to explain the institutional genesis of medical malpractice evaluation, thereby offering historical references for subsequent institutional reforms and innovations in the field.