With rising public expectations and demands for increased accountability, hospitals will be even more challenged by their local communities to implement strategies such as those developed at SMH to enable community participation that assists the hospital in serving its local population into the future. In response to unique health needs of its local community, SMH created an Inner City Health (ICH) Program in the early 1990s to provide comprehensive inpatient, ambulatory, and community outreach services. To build on its philosophy to reduce barriers to health for disadvantaged populations, the ICH Research Program, the only one of its kind in Canada, was also established. This paper will describe and explore the formalised infrastructure between SMH and the community; its evolution, as well as SMH's involvement with its community in context of the hospital's relationships with its Board of Directors, the Toronto teaching hospital system, media and advocacy groups. The role of ICH research in influencing evidence-based clinical practice, innovations in health science education and government policy will also be discussed as part of the SMH's hospital-community infrastructure.