The restructuring of human service organisations into more lean organisations has brought increased work demands for many human service professions. Social work stands out as a particularly exposed occupational group, in which high work demands are paired with a large individual responsibility to carry out the job. The objectives of the study were to identify what kind of coping strategies social workers employ to handle the imbalance between demands and resources in work and to investigate how different strategies affect outcomes regarding health, service quality and professional development. 16 individual interviews and four group interviews with another 16 social workers were conducted. The analysis identified five different main types of strategies: Compensatory, Demand-reducing, Disengagement, Voice and Exit. An extensive use of compensatory strategies was connected with negative outcomes in health. Often these compensatory strategies were replaced or combined with different means of reducing the work demands, which in turn influence performance and service quality in a negative way. The results highlight dilemmas the social workers are facing when the responsibility to deal with this imbalance are “decentralised” to the individual social worker. When resources do not match the organisational goals or quality standards, the social workers are forced into strategies that either endanger their own health or threaten the quality of service.