How governments compel compliance is a central issue of public policy. The move towards contracting specialized services to agencies is characteristic of a movement that emphasizes a certain set of tools intended to enhance accountability. Critics identify a lack of clarity regarding what accountability is and how it works within and across contexts. Using Dubnick’s “promises of accountability” framework, this study aimed to understand how healthcare leaders’ in Government and a specialized agency make sense of accountability in the context of Ontario’s cancer services system. This study was designed using qualitative description and incorporated key informant interviews, document review of historically relevant texts, and informal observation of advisory council meetings. Findings highlight the need to apply both instrumental and intrinsic tools to foster meaningful inter-personal and inter-organizational relationships. Additionally, while instrumental tools seem to operate sequentially, there is less of a distinction between intrinsic tools.