Governance may not be a top priority when debating healthcare transformation for the twenty-first century, but it is a critical instrument to strengthen public and institutional performance (Van Kersbergen and Van Waarden, European Journal of Political Research 43:143–171, 2004; Chhotray and Stoker, Governance theory and practice: A cross-disciplinary approach. Palgrave-Macmillan, Hampshire, 2009). Governance matters, and never more so than in times of crisis. “For example, since 2008, in the UK approximately one in three NHS foundation trusts have been subject to formal regulatory action on at least one occasion, with poor governance a contributing factor in almost all the cases” (Monitor, Care Quality Commission, & NHS Trust Development Authority, Well-led framework for governance reviews. Government of UK. Retrieved from https://www.gov.uk/government/publications/well-led-nhs-foundation-trusts-a-framework-for-structuring-governance-reviews#history , 2014, p. 4). The first two sections of this chapter cover theoretical aspects, including how governance and accountability are conceptualized and specific considerations of governance and accountability in integrated health systems. The latter two sections focus on the practical aspects of implementing governance and accountability into integrated health systems and the tools needed to support its implementation. We have tried to present a balanced view by drawing on a wide range of published literature; thus, while many of the innovative examples we discuss originate in the UK, we believe that they can easily be applied into types of health system.