Creating a system for performance improvement in cancer care: Cancer Care Ontario's clinical governance framework.

Background: Good governance, clinician engagement, and clear accountabilities for achieving specific outcomes are crucial components for improving the quality of care at both an organizational and health system level.

Methods: This article describes the benefits and results reported by Cancer Care Ontario (CCO) in transforming from a direct provider of cancer services to an organization whose responsibilities include improving the quality of care across the province's cancer system. The significant challenges in establishing accountability in the absence of direct operational authority are discussed.