<p>Amid ongoing pressures for efficiency, accountability, and equity in health service governance, this longitudinal case study examined the five‑year impacts of a centralized allied health structure in a large public hospital setting. Building on earlier findings that demonstrated short‑term improvements in governance clarity, workforce flexibility, and professional identity, the five‑year follow‑up explored whether these benefits were sustained and what new challenges emerged as the model matured. Qualitative data were collected from 169 allied health professionals (25% of the workforce) across multiple disciplines and analyzed thematically. The analysis was supported by descriptive ratings of the aims of the restructure from respondents who had experienced both governance structures. Findings indicate that the centralized model continued to deliver enduring advantages in accountability, workforce planning, and professional identity, with staff reporting sustained improvements in morale, transparency, and discipline‑specific oversight. However, participants also highlighted the need for ongoing investment in leadership capability, relief staffing, and adaptive systems to support workforce mobility and integration across diverse clinical contexts. These adaptive pressures became more pronounced as governance boundaries expanded to include pharmacy services and as workforce size increased. Overall, the study provides rare longitudinal evidence that centralized governance can achieve lasting benefits for allied health staff in bed‑based services, while underscoring the importance of continuous organizational support to sustain reform outcomes. The findings contribute to organizational design theory by demonstrating how contingency, accountability, and professional identity frameworks explain the durability and evolution of governance reform in complex hospital environments, and offer practical guidance for health service leaders undertaking structural redesign.</p>