This chapter analyzes general and specific reform programs and reform initiatives. It explains the course and outcome of general and specific processes of change. Policy reforms address policy content and measures directed towards users of public-sector services. Some reforms look nice in the world of ideas, but run into problems when implementing them and the effects might not be what the reform agents expected. Hierarchically-based instrumental thinking would expect a close connection between reform and change. Reform and change in public organizations can occur simultaneously, yet be partially decoupled from one another, in the sense that reforms may be based on initiatives from the top, while change can occur continuously at lower levels of the organization. One aspect of organizations as instruments is expressed in the notion that hierarchically-responsible leaders implement reforms in an instrumentally rational way. From a cultural perspective, reforms may vary immensely across organizations. From a cultural perspective, reform happens slowly and incrementally.