title: Different timetables for change: understanding processes in reorganizations--a qualitative study in a psychiatric sector in Sweden.
abstract: OBJECTIVE
  It is well-known that a decrease in economic resources in health care results in increased workload, stress and pressure on personnel. The main aim of this study was to explore and understand how personnel in health care were influenced by multiple obligations in the context of a changing surrounding.
  
  
  METHODS
  Personnel within psychiatry were interviewed in an open-ended, interactive mode. The transcribed interviews were analysed using grounded theory as the method of study.
  
  
  RESULTS
  These professionals working within a turbulent work situation experienced a struggle between external demands and internal obligations of an ethical or ideological character. For many of them earlier psychological contracts were broken, earlier organizational culture was overthrown and their professional authority was threatened. They were required to change or abandon well-established professional identities. Fundamental changes such as the transition of theoretical framework or revision of internal obligations have quite a different timetable from a technical change of method or organizational structure.
  
  
  CONCLUSIONS
  The findings of two timetables for change should be addressed when considering reorganizations. If these findings are applied to personnel in health care, seeing them also as patients in the system may be avoided.
  
  
  CONCLUSIONS
  The different timetables for external change and internal reorganization, with support from findings in in-depth interviews, have not been described until now.
authors.affiliation: Medical Management Centre, Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Elsmari
authors.initials: E
authors.lastname: Bergin
authors.forename: Michael Helge
authors.initials: MH
authors.lastname: Rønnestad
mesh_terms: D005069:Evaluation Studies as Topic; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D011570:Psychiatry / Q000458:organization & administration*; D013315:Stress, Psychological; D013548:Sweden