A mixed methodology study of inter-hospital alliances in Germany, Canada and Switzerland was conducted to describe the goals and performance of inter-hospital alliances and to identify which alliance features best predict performance. Alliance features and performance were studied through a series of 59 interviews conducted within 12 hospitals involved in such partnerships. Respondents included administrative, medical and nursing staff. A standardized interview schedule was used to document the perceived as well as factual attributes and performance of the inter-hospital alliances they were included in. Results indicated that financial goals were not rated as being as important as improvements regarding service access and quality. A path analysis generated a seven component model of features linked to the perceived success of alliances: environmental, human and structural components of the alliances had an indirect relationship with overall success which was mediated through adaptability. Inter-hospital alliances have similar goals with regards to service quality and access, .notwithstanding the country, the type of health care system and the respondents.