"Heal Thyself": Managing Health Care Reform

Marilyn Mardiros is an associate professor of health sciences at the
University of Ottawa.

At present, health-care reform in Canada focuses on three major areas:
greater integration and continuity of services, better accountability
and quality, and greater emphasis on health promotion and disease
prevention. As health care is increasingly defined as a consumer
commodity and as a business that can be a source of profit, solutions to
problems in the health-care system and health-care reform are sought in
market mechanisms and for-profit management techniques. Yet, as the
authors of this study of health-care reform point out, greater reliance
on the market is associated with an inferior health-care system.

The perceptions of registered nurses (RNs) in British Columbia are used
to illustrate problems with health-care reform. Among the notable flaws
are the failure to recognize the skill and knowledge base of the health
professional workforce and a single management strategy that emphasizes
standardization of all aspects of health care. One result of
standardization is a diminution of professional nursing discretion that
adversely affects the quality of patient care.