This issue of HQ is full of surprises!

The editorial board has taken a broad perspective on healthcare this quarter, and has assembled an interesting set of readings that I hope you will enjoy. We begin with an article by Trevor Hancock who is well-known for his passion for healthy communities. Quite rightly, Trevor emphasizes that health is more than health services and that the determinants of health are complex interrelated factors including but not exclusive to wealth, education, the environment and employment. How complicated our healthcare world becomes when we try to fit the role of hospitals in this broader framework. But please keep reminding us, Trevor. We need to address all determinants of health when we create healthy public policy. The theme of the second feature, by Sholom Glouberman, is also the environment. Sholom provides a step-by-step history of the Walkerton affair from 1995 onwards and offers excellent insights and lessons we can all learn from this experience. We conclude with a case study from Cambridge Memorial Hospital - the first hospital in North America to achieve ISO 14001 designation.

Next, Anna Day and Leslie MacMillan make the case for implementing a model of hospitalist physicians in acute care hospitals. The plight of the "orphan patient" is on the minds of many people - both those within the system and those on the consumer side. Day and MacMillan describe the role hospitalists might play in easing the tension. They also discuss the steps that will need to be taken to support and sustain the concept. This view is shared by William MacDonald and Lynda Monick at Windsor's Hotel-Dieu Grace Hospital, which implemented a hospitalist system several years ago. Conversely, Kenneth Hook and Jan Kasperski from the Ontario College of Family Physicians offer fiery counter discussion outlining some of the problems with going in the hospitalist direction. In a related topic, what is the real story about the supply of physicians in Canada? John Millar's article, based on CIHI data, sheds some light on this issue.

We are delighted to continue our on-going series on nursing issues and the impact on hospitals with a paper from Heather Clarke and her colleagues. This group of nurse researchers is participating in an international research project looking at the quality of the work experience for nurses and its negative or positive impact on nurses' satisfaction with their jobs. The authors also provide a series of strategies to help recruit and retain nurses.

We are also pleased to present readers with the regular columns and features they have come to expect in Hospital Quarterly. Mary Caldbick looks at the implications to hospitals of Canada's e-commerce legislation. We profile Susan Conner who has the daunting task of steering the University Health Network through a $350 million redevelopment project. We have a review of the report, The Financial Management of Acute Care in Canada, as well as updates from the Institute for Clinical and Evaluative Studies, the Canadian Health Services Research Foundation, POLLARA and The Berger Population Health Monitor.

I am also delighted to welcome two new members to our editorial advisory board. Prof. Charlyn Black is Co-Director of the Manitoba Centre for Health Policy and Evaluation at the University of Manitoba, and is currently Special Advisor to the Canadian Institute for Health Information and the Canadian Institutes for Health Research. Dr. Chris Carruthers is Chief of Staff at The Ottawa Hospital and President of the Canadian Society of Physician Executives. Both bring a wealth of experience and abundance of knowledge, and we are pleased to have them as part of the editorial team.

In closing, I would like to recommend some additional reading. In the most recent issue of HealthcarePapers, Dr. Peter Ubel, an academic physician and ethicist in Ann Arbor Michigan and author of Pricing Life, presents his compelling insights into the need for physicians to ration healthcare. The respondents to his paper rise to the challenge and debate this topic with vigour and conviction. It's an issue that is both stimulating and controversial.
Enjoy!

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