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Objectives.To study how medical professionals perceived recent organizational changes and financial cut-backs in terms of organizational and health care quality.

Design.A cross-sectional questionnaire survey.

Setting.County council of Stockholm.

Participants.A random sample (n=936; 70% response rate) of physicians and nurses employed by the county council of Stockholm.

Main outcome measures.Staff perception of how recent changes impacted on staff-perceived quality of care, staffs' skills development, management, and perceived organizational efficacy.

Results.Over 60% of the respondents rated that patients' access to health care had diminished as a result of ongoing changes. A similar percentage also perceived a decline in the quality of health care delivered in general. However, fewer staff rated a decline during the last year in the quality …