Approaches to the management of health care have been framed around two broad conceptions of the nature of the health care process. The mechanistic view of care treats the process as a standardizable production process comprising a relatively unvarying sequence of decisions and tasks. The individualistic view regards medicine as an art not a science and the process one in which the professional uniquely crafts a care management strategy for each patient. Each view is associated with a different set of management tools -- care paths and guidelines in the former case and financial and non-financial incentives in the latter. Both sets of tools are primarily used as mechanisms of control. This paper argues that the true nature of the care process, of which these two views are special cases, is a learning process comprised of a linked set of decision-implementation cycles. These cycles yield both a medical outcome and new information upon which the subsequent cycle is based. As it unfolds the process of health care yields learning for the patient, the care giver, the delivery organization and medical science. An understanding of the nature of care leads managers to manage the process in a different way, for learning not control.

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