Table 1 Synergies frequently noted by participants of the Southern Rural Access Program

Relationship Building

Creating relationships between organizations and individuals, whether at the community, state or inter-state level.

"I believe probably that there were preexisting working relationships. However, I think there were some actual friendships that grew out of this. Because of the ongoing work on the project...with folks that I didn't know before, I will pick up the phone and say "Hey, let's go to lunch and talk about some things."

Shared Information, Shared Know-How

Shared information is communicating substantive information ("know-what") between partnering organizations. Shared know-how refers to communicating procedural ("how-to") information.

"...we worked directly with the other loan funds that were developed in the other states. We shared policies and procedures, ideas, how the structure runs, what worked in some place and what worked in other places. We identified funding sources and shared those ideas with other loan fund staff in other states. During the development process it all helped us learn together how to do health care lending."

Shared Resources

Financial, human and material resources that collaborating organizations pool in order to carry out an activity or program.

"Yeah, the lead agency of the retention and recruitment component – the Primary Healthcare Association – already had a partnership with the Department of Health...but through the SRAP, oh man, it was enhanced and strengthened drastically because we were able to hire a staff recruiter. We placed that recruiter at the Department of Health, in their office, and then two years later the Department of Health, not only were they very satisfied with the partnership, they were able to contribute funds to partially support our recruiter's salary and time."

Increased Capacity

Collaborations that allowed participants to increase the volume of their activities and output

"We were able to make a lot of community partners through these programs and I saw lots of benefits in all the programs. This AHEC is hosted by the state university and we have worked with this university in the past, with the nursing students and the other students, but the SRAP gave us the opportunity to work with other colleges and universities from this region,...so it helped us expand and develop a much stronger program advising college students and directing them into health careers programs. We definitely made some good community partners with some other colleges and universities in the East Texas area."

Cumulative Impact

The additive or multiplicative effects that result from combining distinct but complementary activities and programs

"If I, as a regional recruiter, recruited a provider and they needed some special financial assistance, I could send them the information on our revolving loan fund... There were a lot of times, too, that I used practice management. There were times that I would see some improvements that could be made in different primary care practices and I could refer them to our practice management consultant."

Shared Voice

Efforts among partnering organizations to come together to vie for greater political or market power

"We were also able, over the course of time, to develop with the University of Mississippi Medical Center a Scholarship-Loan Forgiveness program for individuals who would go on to be accepted to the Ole Miss Medical School and would agree to come back to the rural community and become family practice physicians. The legislature actually assisted with the development of funding for that program. There was a lot of people who ordinarily wouldn't lobby together, down at the capital, speaking with one voice."

Gap Spotting and Closure

When organizations recognize needed services or programs missing locally and then provide these services to complement or enhance existing programs

"So there was an observation from the loan fund side that practice management was an activity where clearly professional help was needed. It was being provided in the market to some who can afford, but others who couldn't weren't gaining access to it. It was strongly suggested also by [the NPO] and, as I understand it, by [the state project director] to fund that element. Given the fact that it was encouraged and the need was observed as being there, that led to the generation of it."