Organizational Accountability for Justice and Health Equity

Health-care organizations traditionally view accountability through punitive and performance-metric lenses, failing to address their responsibility to communities most impacted by health inequities. While research exists on organizational accountability in health care, little explores how Black, Indigenous, and People of Color (BIPOC) frameworks might transform health-care delivery toward justice and equity. This article examines how four BIPOC philosophical frameworks-right relations, Seven Generations, calling in versus calling out, and Emergent Strategy-can reimagine organizational accountability to advance health equity. The authors' findings reveal that combining BIPOC accountability frameworks with structural reforms in payment and care delivery systems enables health-care organizations to center relationship-building and long-term community impact. Concrete organizational examples demonstrate successful implementation of these principles through initiatives like the Robert Wood Johnson Foundation Advancing Health Equity program, while personal narratives illustrate their transformative potential in patient care. This work provides practical pathways for health-care organizations to move beyond punishment toward accountability models that prioritize immediate holistic care needs, health equity, and generational community well-being, fostering healing and justice.