In this paper, four qualitative case studies capture the complex interplay between the social and structural relations that shape community - academic partnerships. Collaborations begin as relationships among people. They are sustained by institutional structures that recognize and support these relationships. Productive collaborations centralize reciprocity, flexibility, and re- lationship building between individuals and institutions. Our findings also indicate a synergistic interaction between collaborative processes and outcomes: an equitable process supports the development of mutually beneficial outcomes, and the ability to sustain a collaborative process requires substantive progress towards shared change goals.