Categories of factors likely to influence partnership synergy	Factors fostering or hindering partnership synergy	Primary Care Connection Partnership (PCCP)	Community Health Resources Partnership (CHRP)
Structure		Formalized groups of stakeholders involving in each case: a research team ‐ composed of academic investigators (including Principal Investigators and co‐investigators) and research coordinators (including partnership coordinators); a local partnership core team—comprising the research team, clinicians, decision makers, health care managers, and community partners (eg, representatives of nonprofit organizations working with vulnerable populations, patient partners).
Partner Characteristics	Composition (Lasker et al. model: heterogeneity)	Membership fluctuated over the years, with relatively stable organizational representation but significant turnover in individuals. In 2018 there were 13 members. Total number of stakeholders since the beginning of the project: 30 to 40 stakeholders.	Membership fluctuated over the years, with less individual flow‐through than in the PPCP. In 2018 there were 23 members. Total number of stakeholders since the beginning of the project: 30 to 40 stakeholders.
	Nature and level of stakeholder engagement (Lasker et al. model: level of involvement)	Group of partners referred to as a “steering committee” (011, PCCP) and “IMPACT project” (016, PCCP). Participatory approach to inquiry and problem‐solving. All stakeholders participated actively in the co‐construction of the various aspects of the project, the non‐researchers ‐ on an ad hoc voluntary basis. The researchers' stakes were perceived to be higher. Patient partner representation only at the initial project stage, subsequently minimal community input: “What we are really lacking are patient representatives. This is a hole we have not filled since we had the patient representative who was not quite what we were looking for as for the criterion of vulnerability.” (011, PCCP).	Group of partners referred to as an “advisory group” (013, CHRP) and the project ‐ as “the IMPACT study” (015, CHRP): Well, the meetings it's more […] around discussions, about what they want to do with the project, rather than the actual operational pieces of that. Another part of the team, I believe, has been doing that piece. So it's primarily been more like advisory kind of input. (017, CHRP). Structured way of soliciting input from stakeholders. Meetings were perceived to be confined to gathering information, with an eventual shift to problem‐solving: […] I think, that it changed over time. So certainly at the outset I think it was more information gathering, you know, what's out there, what works, what have you guys tried, who's doing what, that sort of thing, that was at the start. Then I would say there was that phase we have got an idea now but we need some further resources because our grant is not going to cover all this stuff. (015, CHRP). High level of engagement of patient representatives, but not at the initial project stage.
Partnership Characteristics	Leadership	Both partnerships are largely driven by the research teams. Presence of boundary‐spanning formal (academic investigators) and informal (partnership coordinators) leaders knowledgeable about the context and skilled at capitalizing upon the various strengths and perspectives of stakeholders, creating the atmosphere of trust and encouraging different opinions to be voiced: “[…] they [research team members] consult us a lot, I think because of our knowledge of the environment.” (013, PCCP);“[…] there is a very open kind of environment there and frankly and you can tell that the research team really wants to hear what people have to say and so they act […] and they ask pointed questions.” (015, CHRP).
		Leadership distributed among academic and nonacademic stakeholders.	Leadership distributed within the research team.
	Administration and management	Face‐to‐face meetings every two to 8 weeks. Despite the availability of meeting agenda, enough room is provided for deep discussions on issues of concern. Targeted, ongoing communication regarding project activities. Substantial field presence by the research team.	Face‐to‐face meeting frequency: from every 6 weeks to two/three times a year. Frequency is determined by the availability of new information. Experienced one delay between meetings of 1.5 years due to delays in ethics protocols approvals. Effective organization and logistical support for meetings: Well, they do an excellent job of time‐keeping. So I feel that they are very well organized for these meetings. I feel there is not a wasted minute in those meetings. They seem to just be very effective and very planned and organized. So I'm learning from seeing how a well‐organized meeting unfolds. (016, CHRP). Periodic newsletter regarding project activities, with a broader community reach, that some participants admitted to not reading due to busy schedules.
	Decision‐making (Lasker et al. model: governance)	Participants reported that the decision‐making process was transparent and inclusive: “Decisions, I think the fact that you go to a vote […] to decide how to make a change, I think that's good. They take all opinions into account before making a major decision.” (016, PCCP). The decisions … before being made, there is a study, consultation, a consultation process that is undertaken, and that's really commendable. This is done through email exchange. They ask three questions, four questions, following our last meeting, where we had not necessarily identified the solution to resolve our problem. They ask questions, we analyse the answers when we meet again. At that point you have to decide. They submit the hypotheses to us, a proposal, a decision, we discuss it and we decide. So that it is done in a group, it is during meetings that it is done. (013, PCCP).	Nonacademic participants reported a lack of clarity as to how decisions were made: “I'm not sure how […] the leaders … how they decide who's going to do what.” (018, CHRP). Other nonacademic participants argued that decisions are largely undertaken by the research team: “Well, really there's no decisions that are made during the committee meetings per se. I think it's more information gathering for the people who are leading the study. Umm and then decisions are made, I guess, within the project team.” (017, CHRP).
Relationships among partners	General atmosphere	The general atmosphere was described as “good” (011, PCCP) and “open” (013, PCCP): The exchanges are very open. That is to say, when we […] put forth a proposal or a possible solution, it is always well received … not necessarily always accepted, but well received. Lots of openness. That, I find that interesting. (013, PCCP).	The general atmosphere of the partnership was described as “positive” (018, 011, CHRP), “dynamic” (017, CHRP), “respectful” (019, CHRP), “open” and “friendly” (015, CHRP), “collaborative,” “energising” and “engaging” (013, CHRP): “Everybody seems to be happy to be involved.” (018, CHRP).
	Trust	Participants stressed the importance of having signed letters of understanding with institutions at the start of the project. Despite the fact that membership fluctuated, these letters underscored the credibility of the project and facilitated trust‐building with new members.	Participants highlighted the importance of face‐to‐face meetings from the standpoint of trust‐building: […] it's positive and everybody seems to think that they have a … they make a difference, yeah. And so they are in there and people are actually taking notes when they speak, the patients aren't used to having people take notes about what they say. Well, this happens at this meeting, and people actually pay attention. (018, CHRP).
	Conflict	Some participants stated that they did not observe any conflict: “I would say that we did not have any major conflicts in the steering committee.” (011, PCCP). Other participants described strategies used to overcome differences: “I think there is a lot of discussion […] we have the freedom to give our opinion, to discuss. I think it is very appropriate.” (016, PCCP). “I did not sense any conflict, but if there were moments where there was misunderstanding regarding certain aspects, […] it was [managed] through conversation.” (020, PCCP). Some participants referred specifically to overcoming difficulties related to policy changes that affected the partnership: “It's not conflicts, but it's the pitfalls that are difficult to overcome.” (013, PCCP).	Participants felt that they could contribute openly, including voicing concerns and disagreement: “[…] it's a good trusting environment. People are happy to speak up and say what they need to say.” (018, CHRP). Other participants reported observing no challenges: “I never saw anything as a major challenge.” (019, CHRP).
Resources	Financial resources	Both projects were funded under the envelope of the larger IMPACT program. The program provided funds for the coordinating research infrastructure. The research teams spearheaded the program and provided ongoing support to the partnership. The interventions were not covered under the IMPACT program funding. Each partnership was required to mobilize adequate local resources to respond to regional access needs and implement an intervention tailored to the local context. CHRP management activities carried out by the research team located in a research institute, and in the case of PCCP—a research center. Face‐to‐face meetings organized either at the research center/institute, nearby locations, one of partner universities, or a participating community organization.
			In the early stages of the project, acquired additional funding in order to conduct a randomized controlled trial to test the effectiveness of the navigator model.
	Nonfinancial resources	Unpaid time of partnership members; Information exchanged; Skills and expertise; Connections to a broader web of organizational and community stakeholders.
External Context	Community characteristics/ history of prior collaboration	History of pre‐existing relationships and collaboration between research teams of two universities, no past collaboration history between the two health authorities, relationships with community had to be forged: […] it was pretty special, because, all the people around the table did not know each other and had never worked together. Worse even we could see that they were not ready to work together, they had never spoken to each other. (011, PCCP).	History of pre‐existing relationships and collaboration within the research team and with some decision makers and patient representatives, relationships with other stakeholders had to be forged.
	Policy context	Major reform leading to a number of policy changes. The legislation behind the reform was introduced by the Liberal government of the time and included the following Bills: An Act to modify the organization and governance of the health and social services network; and An Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation. Bill 10 served to re‐organize the health and social services establishments under a new governance structure; while Bill 20 served to improve access to primary care through a system of quotas of registered patients: “The change is quite major […]it's a transition, it's difficult, and we are right in the middle of it.” (013, PCCP). The intervention had to be adapted several times to respond to the evolving environmental opportunities and threats.	At the time of the CHRP project activities, the province was undergoing significant changes in its health care system, with services being integrated sub‐regionally based on geographical utilization patterns. These changes were taking place within the framework of tight budgets, contract negotiations, and increasing demands on the system.

Abbreviation: IMPACT ‐ Innovative Models Promoting Access‐to‐Care Transformation.