• Allison Hudson, Andre Daniel Boudreau, and Janice Graham.
• Psychiatry resident at the University of British Columbia in Vancouver. allison.hudson@dal.ca.
• Can Fam Physician. 2019 Aug 1; 65 (8): e344-e355.

ObjectiveTo identify and describe features of relationship-based care that contribute to a successful collaborative model of primary care delivery.DesignFocused institutional ethnography using a critical medical anthropology approach.SettingThe North End Community Health Centre (NECHC) in downtown Halifax, NS.ParticipantsTwenty health care providers employed or previously employed at the NECHC.MethodsQualitative data collection included participant observation, recorded and transcribed semistructured interviews, informal discussions, and policy document analysis. Data collection continued until saturation was reached, between December 2014 and October 2016. Data were member checked, coded, and triangulated with evidence from policy documents and informal conversations to establish credibility.Main FindingsThe NECHC offers high-quality care to the community, welcoming marginalized, vulnerable populations. The NECHC's recognized success is grounded in unique relationships among providers, patients, and the community. Four key themes contributing to relationship-based care in the clinic's operation emerged: an activist provider identity, cultural safety, provider-patient relationships, and provider-provider relationships. Inadequate provincial funding mechanisms limit the work and development of the clinic.ConclusionCollaborative care is advanced by health authorities to improve quality of care and reduce health care costs. This model is still poorly understood in Nova Scotia. The findings, which draw on focused ethnographic fieldwork and analysis of the NECHC, suggest that the NECHC is a pragmatic real-world model of collaborative health care. The success of its approach relies on a deliberative democratic realization of reflexive practice through relationship-based care.Copyright© the College of Family Physicians of Canada.

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