This book is a contribution to managers' helping each other to learn. Most of the papers in the book are written by health service managers; they are not someone else's account of what those managers do or say they do, but the thoughts of the managers themselves on their own work, and on their relative successes and failures. The book is a collection of papers which were first written for discussion during an international seminar. The seminar included health care managers and policy makers from the United Kingdom, the United States, Canada, Australia and New Zealand. After the seminar, several of the participants' papers were revised to reflect the co-learning that had taken place and those papers are included here.