This chapter analyses the information gained from three case studies and shows what models of accountability are dominant in the Canadian health care systems, what their interrelationship is and what management practices they drive. The case studies are: Quebec, Alberta and Ontario. The chapter discusses recommendations to reframe accountability in health care organisations. It argues that fitting the pieces of puzzle metaphor together requires that attention be paid to the size of each piece, intersection points, divergence points and complementarities. The chapter highlights four main models of accountability in the context of the health sector: the political model, the professional model, the bureaucratic model and the managerial model. Data collected from interviews in Quebec show evidence of a codominance of professional and bureaucratic forms of accountability with explicit attempts to introduce components of managerial and political accountability. The political model combines principles of participatory and representative democracy and fosters the input of the population in decision-making.