This case study examines a reorganization within specialist psychiatric care in Region Värmland, where eating disorder services were restructured in a way that took effect on January 1st 2022. The case study is based on document analysis and aims to explore how the change process was carried out, focusing on preparation, decision-making, implementation, and communication.

The change initiative began with a letter from patients and proposals from staff at the Centre for Eating Disorders (CFÄ). The original goal was to establish an age-inclusive inpatient unit for patients with eating disorders. However, the final outcome was an inpatient unit for children and adolescents with psychiatric conditions, and the transfer of CFÄ’s child team to Child and Adolescent Psychiatry (BUP).

The analysis uses a combination of Kotter’s 8-step model for leading change and Maurer’s theory of resistance on three levels. The documents show that the change process did not follow a clear or linear structure. The underlying reasons evolved over time, and communication and participation appeared inadequate. Resistance primarily emerged toward the end of the process, with several types of resistance identified, including a lack of trust in leadership.

The conclusion is that the process was characterized by ambiguity about what was to be accomplished and why, as well as who was responsible. The clearest rationale, the establishment of inpatient care for children and adolescents, was not the original driver of the change initiative. The part of the reorganization that caused the strongest resistance was the transfer of the CFÄ child team to BUP. These reactions appear to be a result from an unclear vision, lack of participation, and insufficient communication during the course of the process.

All decisions were made by civil servants, with no involvement from political leadership. Suggestions for further research include examining the experiences of those affected, differences in perceptions between managers and staff, and the question of when political actors should be involved in organizational changes in healthcare.