Initiatives to improve the quality of care in Ontario’s publicly funded health-care system are a prominent focus of current policy, with the introduction of the Excellent Care for All legislation. Cancer Care Ontario (CCO) commissions the full range of ambulatory cancer treatments along with surgical wait time reduction efforts. Within Ontario, CCO has been a leader in quality improvement initiatives in the past 10 years, using a number of strategies to continually improve the performance of cancer services. These include regularly reviewing the performance of each regional cancer centre and working with regional vice presidents and clinical leaders to address problems. These strategies also include the provincial-regional alignment of leadership objectives, provision of funding contingent upon results, and the reporting of results to cancer care providers and the public. From his perspective as the leader of a health-care commissioning agency with a core commitment to quality improvement, Dr. Sullivan will speak on lessons learned and possible considerations for the commissioning of health services more broadly.