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Health initiatives often require collaborations between multiple organizations. Coordination between organizational leaders is central to the success of these collaborations. This presentation explores how relationships between leaders can facilitate or constrain organizing processes and goal achievement in inter-organizational health collaborations. Specifically, recent work on leader-leader exchange theory (coming from leader-member exchange theory) is offered as a way to understand the influence of these high-level relationships on organizational partnerships and consequently on the success of health initiatives. Next, adopting a communicative perspective, this presentation examines how leader-leader relationships are discursively constructed for and subsequently used by members from the collaborating organizations who are responsible for the day-to-day implementation of the health initiatives. Finally, this presentation offers guidelines for leaders who are establishing inter-organizational partnerships and potential pitfalls are explored.