title: Accountability in the ontario cancer services system: a qualitative study of system leaders' perspectives.
abstract: Cancer Care Ontario (CCO), the provincial cancer agency, operates under a model of accountable governance that has been hailed as exemplary. We explored cancer system leaders' views on the balance and perceived efficacy of approaches to accountability in this context. Semi-structured interviews were conducted with 19 participants (MOHLTC=5, CCO=14). Adopting a qualitative descriptive approach, we coded data for four policy instruments used in approaches to accountability. Financial incentives are a key lever used by both parties to effect change. Cancer-specific regulations were somewhat weak, but agency-wide directives were a necessary nuisance that had great force. The effect of public reporting on mobilizing consumer sovereignty was questioned; however, transparency for its own sake was highly valued. Professionalism and stewardship, with an emphasis on trust-based partnerships and clinical engagement, were critical to CCO's success. These approaches were seen to work together, but what made each have force was reliance on professionalism and stewardship.
authors.affiliation: Graduate Student, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bytautas
authors.affiliation: Associate Professor, Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON.
authors.forename: Mark
authors.initials: M
authors.lastname: Dobrow
authors.affiliation: Professor, Institute of Health Policy, Management & Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
authors.forename: Terrence
authors.initials: T
authors.lastname: Sullivan
authors.affiliation: Associate Professor, Institute of Health Policy, Management & Evaluation and Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
authors.forename: Adalsteinn
authors.initials: A
authors.lastname: Brown
mesh_terms: D001291:Attitude of Health Personnel; D002173:Cancer Care Facilities / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D007883:Legislation, Medical; D008134:Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D017146:Models, Organizational; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000379:methods / Q000592:standards*; D036301:Qualitative Research; D012052:Reimbursement, Incentive; D012941:Social Responsibility