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Background The structure and contents of the health and medical service have changed in recent years. The merger of Norra Älvsborgs and Uddevalla hospitals into one local district under one leadership (the NU medical service) is a Swedish example of a structural change.

Aims This study intends to describe and analyse the staff’s experience of a recently accomplished structural change in the local district NU medical service in the western part of Sweden.

Methods This study has been carried out from a qualitative point of view inspired by grounded theory. From a theme guide with specific questions, 31 interviews were carried out with staff working in the NU medical service.

Findings Four categories emerged from the body of interviews: ‘participation’, ‘doubts’, ‘anxiety’ and ‘faith’. ‘Participation’ was defined as an overall core category, and was related to the other categories. The categories ‘doubts’, ‘anxiety’ and ‘faith’ were related to sub-categories and affected by the overall category ‘participation’.

Conclusions The overall results point to the importance of participation of staff members concerned. The role of the leadership when undergoing structural changes is considered as a major factor to make other staff members participate.