Writing in this journal in 1998, Brunelle et al. described a transformed healthcare system in which hospital trustees had become "advocates and champions of the constantly escalating needs of their individual hospitals" (Brunelle et al. 1998). Despite the myriad changes in the healthcare system that have occurred since that article was written, the observation still rings true today. Unfortunately, while many boards have concentrated on advocating on behalf of their hospitals during this period of transition, not enough attention has been paid to rethinking and restructuring hospital governance to better meet the challenges of change. This series of articles will draw upon the experiences gained from operational reviews of hospitals across Canada to suggest approaches to building more effective governance through:

• Effective and efficient board structures and processes.
  
• Long-range planning.
  
• Financial oversight.
  
• Quality oversight.

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