by Dr Ishma Harford
The notion of running healthcare like a business is contentious.
What usually comes to mind is the popular and perhaps familiar experience of patient processing: a patient is hurried through the consultation and ultimately ends with little satisfaction from the interaction and less in their pockets.
While this is a lived reality for some, and may be misconstrued as efficiency, it is not the true essence of business practices in health. Delivering healthcare is immensely complex and involves many moving parts. Planning, procurement, supply-chain management, capacity building, monitoring, improvement, quality assurance, workforce development, and the list goes on. In essence, these are all core activities of running a business, with the exception that it is not a good being traded, but perhaps the most valuable service that a person may need.
In profit-driven business, value for the customer is often compromised for that of the shareholder. On the other hand, healthcare requires a patient-driven orientation and value delivered for all stakeholders. Who the stakeholders are varies as much as their perspective on value, which itself can be defined in many ways. To facilitate accountability and objectivity, value can be measured in outcomes.
For the patient, the desired outcomes are good health and dignity. For the practitioner, career satisfaction, fair compensation, and a positive work environment. For the government, health system performance and a defensible budget. For the taxpayer, whom every stakeholder ultimately becomes, it is efficiency, proper management, and trust.
In principle, none of these outcomes contradicts the others. In practice, they compete. The patient wants quality care and unhurried time; the taxpayer wants efficient use of resources and accountability. The practitioner wants fair pay; the steward wants a defensible wage bill. The patient wants unlimited drug access; the nation must prioritise those it can afford.
Consider the chain of consequences. If the government budgets well, sets the direction and builds capacity, middle management has room to do more. If middle management is well staffed, well trained, and given the tools for success, the workforce carries less strain. If the workforce is humanely managed and properly equipped, the patient receives better care. If supply chains are maintained and refined, shortages stop dictating what care is possible.
If each layer follows the best practices of its own discipline, the competing values begin to reconcile. Not entirely, because resources are finite and some tension between stakeholder outcomes is unavoidable in any system. But that residual tension is not what is being felt on the ground. Most of what is being felt is manufactured. It is the gap between what the pieces could deliver if they worked synergistically and what they deliver when they do not. Better management is easy to say and hard to do, and the work of it cannot be understated. But the competition between stakeholder values that dominates lived experience is not the price of scarcity, but of poor alignment and management.
This is where business practices, refined through continuous improvement, earn their place in health. Not as instruments of profit, but of coherence, holding the competing expectations together while delivering positive outcomes. Planning aligns capacity to need. Procurement aligns cost to quality. Supply chain aligns availability to timing. Quality assurance aligns what is delivered to what was promised. Workforce development aligns the people to the work.
Where these practices are absent or weak, the system is not neutral. It tends towards waste and misalignment and ultimately, unwanted outcomes.
The question, then, is not whether healthcare should be run like a business, but how do we use business practices to make healthcare deliver more of the outcomes we collectively need.
Dr Ishma Harford is a medical doctor and a Commonwealth Scholar completing a master’s degree in Health Analysis, Policy and Management. The Health Imperative is an educational, non-partisan column about health, the system that delivers it, and all the implications in between.
NOW Grenada is not responsible for the opinions, statements or media content presented by contributors. In case of abuse, click here to report.
