Transparency and accountability in healthcare: bridging antiracism and quality improvement to advance health equity

The terms transparency and accountability appear in various disciplines and frameworks as organizational ideals or guiding principles for governance, but there is limited cross-sector analysis of what these terms mean and how they may be employed to advance population health equity. Two models guiding current healthcare improvement processes, Learning Health Systems and High Reliability Organizations, reference transparency and accountability but lack an explicit emphasis on the role they play in eliminating racial disparities in healthcare. In this commentary, we examine ideas developed by community organizers such as the need for transparent communication across sociological levels (e.g. community, organization, and interpersonal levels) and accountability to historically and systematically oppressed groups by actively shifting power from institutions to community members. A multilevel view of transparency and accountability can guide healthcare systems as they navigate the complex task of undoing structural racism in their institutional policies and practices. The Veterans Health Administration, a national healthcare system committed to being a Learning Health Systems and High Reliability Organization, should draw lessons from community organizing to make transparency and accountability to Veterans from historically oppressed identity groups central principles guiding quality improvement efforts.