Shifting the Power Balance: Creating Health System Accountability through Trusted Community Partnerships

Hadley Fitzgerald
Zackiya Grant-Knight
Sarah Martino Zachary Gross
March 2023
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This report outlines practical approaches to guide health systems in more meaningfully involving community members and being more accountable to the communities they serve.


Health care systems are increasingly interested in engaging with communities to promote health equity, particularly safety-net systems serving communities that disproportionately experience significant health disparities. Health systems can face challenges in authentic engagement with historically marginalized communities, where health systems may have knowingly or unintentionally caused harm and damaged trust. Restoring trust and building authentic relationships between health systems and communities involves shifting the balance of power by involving community members in health system program and policy decision-making.


This report summarizes takeaways from interviews with 25 health care stakeholders, primarily health system leaders and subject matter experts, on the role of health system power and accountability. It outlines key recommendations to guide health systems in involving community members in decision-making and creating opportunities for greater accountability. The report starts with principles for building relationships with community and concludes with implementation considerations for community engagement efforts.


This report offers valuable insights for health system leaders looking to establish or enhance community engagement initiatives to advance health equity.  

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