“Heal Thyself:” Managing Health Care Reform by Pat Armstrong, Hugh Armstrong, Ivy Bourgeault, Jacqueline Choiniere, Eric Mykhalovskiy and Jerry P. White, Aurora: Garamond Press, 2000, 171 pp., ISBN 1-55193-024-2.

It is intriguing and disheartening to review this book at a time when the management of human resources and industrial relations in British Columbia health care has been thrown into utter turmoil by the Gordon Campbell Liberal government. The book, a probing critique of the former NDP government’s health care reform policy, has been overtaken by events. The new government has torn up collective agreements and accords between management and labour, destroying the most advanced labour adjustment program in Canada. And what domain in the work world cries out more for effective adjustment? The government is in the process of sending collective bargaining and labour standards legislation back almost to industrial prehistory. It has closed health care facilities and proposes to privatize others without union successor rights. Prospective private employers have been exposed endeavouring to eliminate the more militant unions from the new labour scene. Certainly this plays havoc with the lives of health care workers. But it also makes life very difficult for researchers actively studying those lives. Such is the nature of health care reform in Canada that just when you think you have accurately described the situation, everything changes. Veteran health care scholars Pat and Hugh Armstrong have become well-known for their attempts to investigate health care reform in a novel fashion, a method few others have even cared to employ: they speak directly to the workers delivering the care. In a series of publications in the last decade, the Armstrongs and several associates have sought out the opinions from those on the front line—patients, families of patients, nurses, LPNs and others. These are truly the (to use a phrase devised by these authors) “Voices from the Ward.” In their most recent book Heal Thyself, these researchers set out to investigate British Columbia nurses’ evaluation of the progress of the health care reform through the nineties. They take as their point of departure a series of seminal documents that began the process of reform in that province. The 1991 report of the British Columbia Royal Commission on Health Care and Costs, Closer to Home provoked the Ministries of Health and Seniors to prepare a health reform strategy entitled “New Directions.” These documents mandated the integration of the separate subsectors of health care (acute care, long-term care, mental health, public health and home care) and the devolution of control downward from government and upward from institutions to new regional health authorities. In addition, the strategy identified five major components of reform: a focus on prevention; greater public participation and responsibility; a move away from institutions and toward the home and community; respect for the health care provider; and more effective management of the health care system. Heal Thyself holds those five directions up to scrutiny, both by the authors and by a group of British Columbia registered nurses working in several health subsectors. The reason for going after nurses’ opinions is straightforward, in the words of the authors: “Registered nurses make up the bulk of the health care labour force. In 1997, there were more than 200,000 registered nurses employed in Canada and three-quarters of them provided direct care in institutional settings. They not only experience the impact of reforms directly in their daily work, they are also often in a better position than doctors, policy makers or managers to see and assess the impact on the patients in their care. RNs have more regular and prolonged contact with patients and their families than do the physicians who direct the care or the managers who supervise the system. As a result, they are in a position to …