This article describes the level of implementation of health technology assessment in Quebec university teaching health centres and examines structures that may facilitate its development. The data are from a mail survey sent to respondents in all university teaching health centres (response rate of 83/149 = 56%). Interviews with key actors (n = 4) were also conducted to document the broader context in which health technology assessment is implemented. The main obstacles identified are the lack of human, material, and financial resources. Respondents pre- fer structures where the health technology assessment unit is under either the CEO or the Chief of Medical Staff, both closely linked to the research centre. The results reveal three key challenges: the need to clarify expectations about the role of health technology assessment, the need to seek consensus around health technology assessment, and the need for broad commitment to the selected structure.