This paper draws upon a model for analysing institutional transformation originating from the Governmentality-tradition in social science. The model suggest a distinction between three separate between modes of institutional transformation: ‘problematization’ refers to the manufacturing of the conditions of possibilities for change, ‘programmatics’ to the envisioning of a new regime in a domain of society and lastly the actualization of change, where new ideals, forms of knowledge and new aims are technically designed as permanent systems of positing and governing a new institutional reality. The model, and the way we apply it, makes it possible to display change processes over time in a systematic way. That is particularly important with respect to institutional transformation which is characterized by change in several dimensions, across different layers of organized action in iterative, and sometimes halted, processes. The model is used to analyse a crucial phase in the transformation of Swedish health care, starting in the 1980s. We end our analysis 2010 when the new regime for governing health care in Sweden has become dominant.