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Almost and Mildon (2022) appropriately address a foundational human value in their article - that of respect for the inherent worth of a person and for their contributions to work, society and life. The article caused me to reflect on the various levels of respect and disrespect I have experienced in my life as a registered nurse and as a woman, and the fact that the two are entirely intertwined. I am frustrated that the gains made on respect for women and respect for nurses have not been sufficient or enduring enough to make life better for nurses and women today. Almost and Mildon (2022) articulate how much more work needs to be done.

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One of the major themes uncovered by Graham and Sibbald in their analysis of the 50-year-old issues of Hospital Administration in Canada (HAC) is the evolution of nursing. However, the HAC approach 50 years ago was that nursing was a problem to be solved, not a resource for health, the health system and the public, and that image would stay with nursing in Canada for many years to come. The recent commissioning by the Canadian Nurses Association of a National Expert Commission to examine sustainability of health and the healthcare system, and the resultant report, The Health of Our Nation, the Future of Our Health System: A Nursing Call to Action, released in June 2012, reflect a significantly different expectation about nurses and the nursing profession - they are not problems to be addressed, but are leading the solutions to better health, better care and better value. And patients are not passive recipients of care decided on by professionals alone, but central team members - "CEOs of their own healthcare" - in an inter-professional patient-/family-focused team that collectively supports people in their health journey. A number of examples of potential articles about and from nursing, based on the findings of the National Expert Commission, are included to illustrate how nursing should be reflected in an issue of HAC in 2012.

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Saskatchewan was the first province in Canada to establish a Quality Council. Fall 2012 would mark the 10-year anniversary of this unique change agency. This article looks back on what the Health Quality Council has achieved to date working collaboratively with its health system partners and looks ahead to coming challenges and opportunities.

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The paper by Shamian and El-Jardali provides a timely and important overview of research on healthy work environments and its translation into policy and practice. Although the research is abundant, progress is slow, with most of the efforts focused on nursing. The paper unfortunately does not give justice to key research and policy documents generated by the national nursing and physician sector studies. The elements of healthy work environments common to these two studies speak to the need to approach healthy work environments in a multi-professional manner. They also speak to the need for work environments to address career life cycles in order to foster effective recruitment and retention of health providers. While the authors are subtle in their suggestion of this, this commentary is more explicit in proposing such action. The need to create healthy work environments is urgent, as providers, patients and the system suffer with continued inertia.

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The Southern Saskatchewan/Urban Aboriginal Health Coalition is an interdisciplinary, intersectoral team of researchers and communities dedicated to exploring what 'culturally respectful' care means in Aboriginal communities. Although the purpose of the research project was to examine this concept in an effort to improve health care service delivery and education for health professions, the members of the Coalition realized early in the process that one of the primary factors related to the success of the project would be the building and sustaining of relationships. This paper describes a relational process that was used to initiate, facilitate, and support a research partnership with the Aboriginal communities. Through a community-based process, two communities and the Coalition used sharing circles and workshops as a method to create relationships and begin a discussion about what constitutes key elements of culturally respectful health care and education. These elements have not yet been determined as the Coalition and community members have focused on fostering relationships which have been critical to building the partnership with the Aboriginal communities.

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Quality councils are an increasingly common phenomenon in Canada. The Health Quality Council in Saskatchewan, the largest such council in Canada, is similar to other councils in that it reports publicly on quality of care, but it differs in that it has an explicit, central role to support quality improvement activities. The HQC strives to gain buy-in and cooperation from provider groups, even those identified as having suboptimal care, by offering them quality improvement training, measurement tools, information about best practices and advice from experts in change management, group psychology, process redesign and operations research. Developing relationships with stakeholders is a very labour- intensive process, but it is essential to fostering a blame-free culture of quality improvement. The HQC works with senior leaders to help coordinate province-wide priorities for quality improvement and with middle managers and frontline staff to establish local quality improvement teams. It does not alter the structure of existing accountability relationships; rather, it tries to make the dialogue more quality-focused. Its largest-scale activity is a Learning Collaborative involving 20% of all family physicians in the province in an effort to improve chronic disease management. The HQC believes that these targeted, coordinated activities in quality improvement will ultimately be far more effective than simply releasing reports or making recommendations.

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