Through my service on the Board of the Health Quality Council in Saskatchewan, I have come to appreciate the capacity of provincial Health Quality Councils to be agents of transformative change in their own jurisdictions. However we still lack political will and effective political leadership in this country to establish and sustain any effective pan-Canadian strategy for healthcare transformation. The COF Healthcare Innovation Working Group is a noble concept but it will not deliver substantive pan-Canadian improvements so long as it is operated off the side of a few desks in otherwise preoccupied provincial/territorial Health Ministry offices.