Organizational Justice and Health Equity in Rural Japan: A Case-Based Analysis of a Hybrid Community-Hospital Organization.

Rural communities face persistent health inequities driven by geographic isolation, workforce shortages, and limited access to institutional healthcare. Hybrid organizations that bridge hospitals, local governments, and communities have been proposed as promising mechanisms to address these challenges; however, empirical analyses describing how such organizations operationalize social and organizational justice remain limited. This study aimed to descriptively examine how a hybrid community-hospital organization in rural Japan operationalizes organizational justice through its structure, practices, and governance, using established frameworks of organizational design and social justice. We conducted a descriptive, theory-informed organizational case study of an anonymized non-profit organization operating in rural western Japan. This analysis did not evaluate health or service outcomes. Data sources included organizational documents, program records, and reflective analyses of ongoing activities, such as digital health consultations and community health dialogues. The analysis was guided by Mintzberg's organizational configuration framework and Fraser's multidimensional theory of social justice, encompassing redistribution, recognition, and representation. The organization exhibited a hybrid configuration combining elements of professional bureaucracy and adhocracy. Key activities - social networking services (SNS)-based health consultations, community health salons, and interprofessional communities of practice - illustrated how organizational structures and routines facilitated access to health information, recognition of residents' experiential knowledge, and participatory decision-making. These practices demonstrated how organizational justice was enacted internally through relational trust and participatory processes, while externally aligning with social justice principles. However, reliance on informal coordination and volunteer labor revealed structural tensions related to sustainability and workload. This case study illustrates mechanisms through which organizational justice can be embedded in hybrid community-hospital organizations and how such designs may support health equity in rural settings. Although situated in Japan, the case offers analytically transferable insights for other rural and resource-constrained healthcare systems facing similar challenges of professional dominance, community marginalization, and institutional fragmentation. The findings highlight both the potential and limitations of justice-oriented organizational designs rather than their effectiveness in improving outcomes.