ISO 9001:2008 (as I understand it based on the drafts issued so far and numerous articles on many websites) will have major changes w.r.t the following:
1. Training has to be seen in the context of competence and not merely training effectiveness. There should be clear demonstration of training results in terms of the impact on competence enhancement
2. Infrastructure will now include the computing and other IT facilities provided to employees
3. MR role can't be staffed with an external consultant - MR must necessarily be from the Management Team
4. Management of outsourced processes needs to be done with higher rigor
5. In addition to the above, at various places additional notes or changes have been introduced to aid clear and consistent interpretation.
On the whole, the implementations of improvement/quality programs will not require significant operational changes. However, from a tactical and strategic angle there are many changes which are required. An example of this - even in a smaller company someone from the management team will have to take the mantle of being the MR (I can see this itself making a sea-change to the ISO Programs!)