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This paper presents the empirical research results conducted in a Swedish care organization for elderly and handicapped. The objective of the research was to empirically assess the implementation and practices of a quality system (ISO 9000) from an organizational change and development perspective. The empirical data were collected through multiple methods; interviews were carried out with key‐persons and leadership in the organisation and surveys were conducted to all employees. Interactive methods have been applied to various groups in the organisations e.g., directors, supervisors, and the leadership of the quality project and the local politicians. The empirical findings indicate, among others, taht the implementation processes were received and perceived differently in the different parts of the care organisation due to different leadership strategies and employee involvement policies. Other critical factors such as acceptance, resistance, motivation, commitment, the role of leadership, learning possibility, etc. have also been investigated, analysed and discussed. Finally some recommendations on how to approach organisational change as well as strategies for implementing a quality system in the care sector are presented.