Participatory Practice in Pursuit of Social Justice

The idea that people should have a voice in decisions that affect them is now widely accepted in the US health sector. Practices such as patient and family advisory boards, community-based participatory research, patient-centered research, and public deliberation are becoming commonplace. The appeal of public participation turns on a number of purported benefits, including the potential for more inclusive and transparent decision-making, equitable interventions and outcomes, and public trust in institutions. Considerable conceptual work has refined definitions and frameworks of participatory processes, and ample experimentation is underway. Yet participation remains an ambiguous concept and highly variable in practice. Drawing on the authors' collective experiences in life and work, this article clarifies what participatory processes are, describes how they might support varied goals of justice, and identifies opportunities and considerations for their use in health-care organizations. Although participatory processes alone cannot solve the erosion of trust in American health care or remedy marked US health inequities, they can be an important tool for health-care leaders who wish to work toward building fairer health systems, services, and outcomes.