Anyone who works in the public administration is faced by a constant flow of new ideas and reforms. New reforms may cause values and ideas to oppose each other and create managerial policy dilemmas, both from an internal and external perspective. The purpose of this essay is to create a better understanding of how these administrative policy dilemmas may create opposing guidance. This is made by examining a new reform that is being applied within the healthcare system in Region Västmanland. Through a strategic selection and semi-structured interviews with senior managers in Region Västmanland the study has been able to answer the questions, of the management’s view of the reform and whether the reform can create administrative policy dilemmas. The study's results have shown that the reform can cause administrative policy dilemmas that include legitimacy, knowledge, implementation and governance. The administrative political dilemma of knowledge was most evident among the interviewed managers. At the end of the discussion, the study has emphasized the most frequent value conflicts and suggest new potential fields of research that has been identified by this study.