Background: The objective of this work was to develop recommendations for the organization and delivery of focal tumor ablation services. New, minimally-invasive ablation technologies such as radiofrequency ablation (RFA), microwave ablation (MWA), and transcatheter arterial chemoembolization (TACE) offer treatment options for patients with a variety of cancers. These emerging therapies can improve patient care (minimize side-effects, offer more rapid recovery with comparable or enhanced outcomes) compared to traditional approaches. However, they are often resource intensive, necessitating a planned system-level approach to ensure appropriate access to high quality services while optimizing care and resource utilization. Methods: This work was led by an Advisory Committee with regional, clinical, administrative and patient representatives and was based on best available evidence, current practice in Ontario, Canada, and guidance from other jurisdictions and experts in the field. A variety of data sources (clinical, system, provider), consultation with external stakeholders and consensus building supported the final recommendations. Results: Thirteen recommendations were developed. Clinical criteria are detailed for RFA for liver, kidney and lung tumors and TACE for hepatocellular carcinoma. MWA is not recommended for lung, liver or kidney tumors. System recommendations include infrastructure (capital equipment, multidisciplinary management and case conference review), the importance of volume-related expertise, and oversight for funding and collaborative planning. Results were broadly disseminated through 12 stakeholder groups connecting with over 40,000 individuals. Conclusions: A systematic approach to understanding opportunities and challenges for focal tumor ablation therapies resulted in multi-level recommendations spanning clinical criteria through to quality oversight. These recommendations will support improvements in care delivery in daily practice and at the system level.