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Introduction: The World Health Organization (2017) issued a call to improve health system performance through better coordination and integrated care. However, "the literature does not contain a one-size-fits-all model or process for successful integration, nor is there a firm empirical foundation for integration strategies and processes" (Suter et al., 2009). To implement effective inter-sectoral collaboration requires political will and innovative solutions to build communication across sectors to address local population needs (WHO, 2017). In 2017, 76 new cross-sectoral teams or "Tables" were created in Ontario (Canada) to address local population health needs. This provided a unique opportunity to conduct research to learn "how to" enable health systems integration and transformation through collaboration among diverse stakeholders. In this research, six "Tables" were studied; two were "Rural Tables", two were "Suburban Tables", and two were "Urban Tables") from 2018-2019. Aim/Objectives/Theories/Methods: The aim of this study was to understand the patterns of communication and collaboration among the participants of six "Tables". This research was innovative as it used both Relational Coordination and Complexity Theories in the context of health systems integration and transformation. The objectives were: 1)To identify key success factors/challenges to understand "how to" build cross-sectoral collaboration for leaders. 2)To develop a policy framework on "how to" build cross-sectoral collaboration for health systems integration/transformation for policymakers. A mixed-methods approach was used with Methodological Triangulation, which included quantitative surveys (at baseline and follow-up), qualitative interviews and member checking. Highlights/Results/Key Findings: The survey response rate was 62% at Baseline (n=45) and 25% at Follow-up (n=22). Relational Coordination Index Scores were "moderate" with no significant differences between Baseline and Follow-up and no differences between the stakeholders or "Tables". From the twelve interviews, it was discovered that context matters at the local levels. "Rural Tables" with "moderate" Relational Coordination reported "inter-dependency" and the "Suburban Tables" with "weak" Relational Coordination reported "inter-organizational challenges". The findings characterized the process of intentional cross-sectoral collaboration using both Relational Coordination and Complexity theories to understand the patterns of communication and collaboration among the stakeholders and the "Tables". This research was unique as the stakeholders collaborated voluntarily and were self-organized without any formal governance or structural changes, interventions, accountability targets or measurement of outcomes. This research adds a much-needed knowledge on cross-sectoral collaboration for leaders and policymakers in the development of self-organizing capacity supported by Relational Coordination. Conclusion: A policy framework on "how to" build cross-sectoral collaboration for health systems integration/transformation has been developed. The framework includes engaging with patients/families and key stakeholders, assessing relational coordination and structures, addressing health care as a complex adaptive system, and evaluation. Even though these proposed strategies are novel, further research is needed to drive health systems integration. Implications: In the literature, there is no one-size-fits-all model for health systems integration. Based on this conundrum, it is recommended that leaders view health care as a Complex Adaptive System; to allow the system to transform, change, and to develop inter-dependencies, interorganizational relationships and self-organizing capacities. Lessons learned from health systems integration in Canada are shared. [ABSTRACT FROM AUTHOR]