Background: Canada utilizes a public payer, private health care delivery model, delegated sub-nationally. Effective coordination of uniform access to safe, high quality care can be challenging in this and similar international models. Quality improvement in radiotherapy (RT) involves approximately 50% of all cancer patients who will require RT during their illness. The Canadian Partnership for Quality Radiotherapy (CPQR) is a national quality improvement approach employing pan-Canadian engagement of a multi-disciplinary group of physicians, allied health professionals, administrators and patients. The objectives are to create a national culture of safe, high quality RT delivery for all patients; develop and implement a comprehensive sustainable national program for safe, high quality RT. Methods: All CPQR QA products/programs are processed using standard methodology of review and validation through community consultation, and endorsed by national stakeholders. QA products are incorporated into national QA guidelines and indicators for RT programs, technical equipment and patient experiences; integrating these into a national accreditation program; developing a national RT incident reporting and learning system. Active dissemination strategies use bottom-up and top-down approaches. Results: The national RT programmatic QA guidelines and key quality indicators were released in 2011 and 2013, with 3849 downloads. Approximately 50% of Canadian RT centres indicated implementing CPQR guidelines and changing local QA practices. 9 equipment QA guidelines were developed and validated, 6 are in development. National monitoring and learning structures are being developed through an accreditation program and incident reporting repository to be operated by national organizations for sustainability. Knowledge exchange activities included 26 presentations and 10 national/international invited discussions. A national systematic evaluation process will be executed shortly. Conclusions: CPQR’s national RT QA development and implementation approach is a successful model that can be adopted in other areas of healthcare considering system improvement.