title: Using clinical governance levers to support change in a cancer care reform.
abstract: OBJECTIVE
  Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation.
  
  
  METHODS
  The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations.
  
  
  RESULTS
  From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives.
  
  
  CONCLUSIONS
  To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers.
  
  
  CONCLUSIONS
  This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Brault
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Denis
authors.forename: Terrence James
authors.initials: TJ
authors.lastname: Sullivan
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration*; D054976:Clinical Governance / Q000458:organization & administration*; D018166:Health Care Reform; D006801:Humans; D007407:Interviews as Topic; D064887:Observational Studies as Topic; D009864:Ontario; D036301:Qualitative Research; D011787:Quality of Health Care
keywords: Cancer services; Change management; Clinical governance; Healthcare; Professionals; Quality healthcare