Recent national and provincial reviews on the status of healthcare in Canada have recommended the establishment of quality councils to guide quality improvement efforts. The emergence of quality councils, such as the Health Quality Council of Alberta, the Saskatchewan Health Quality Council, the Cancer Quality Council of Ontario and the Health Council of Canada, reflect new but largely unscrutinized models for improving quality of care. We discuss the varying mandates of these new quality councils, their fit with evolving governance and accountability structures and the credibility and legitimacy of their role as perceived by other health system organizations. To further illustrate these issues, we present insiders' perspectives on the Cancer Quality Council of Ontario's activities over its first three years, including the initial agenda, critical success factors and the nature of evolving relationships with other organizations in Ontario's healthcare system. While current Canadian quality councils represent an eclectic mix of methods for achieving improvements in quality of care, it is not entirely clear how quality councils will stimulate sustained and significant improvements in quality of care where other models have failed. However, these new Canadian quality councils represent natural experiments in motion from which much needs to be learned.