Dialogue between the leaders of academic clinical organisations in different countries has revealed that the core elements of the partnership between universities and health care systems are remarkably consistent across national boundaries. There is now an impetus to move beyond analysis of common challenges and towards strategies for success that draw on international experience. This paper summarises some of the conclusions that emerged when leaders of teaching hospitals, health care systems, health professional schools and universities met to learn from international experience and to identify strategies for success. The conclusion reached is that these organisations must articulate their unique role in national health systems, communicate their underlying values and redefine the social contract with their national and local communities. (Contains 1 note.)