# How can we balance revenue and a social mission without losing our footing?
Canonical source: [https://www.braver.net/en/blog/how-to-balance-revenue-and-a-social-mission/]()
The Braver journal
The COVID crisis is shaking up our entire planet, and Quebec is no exception. And to tell the truth, neither am I.
![Marie-Lou Gagnon]()
Marie-Lou Gagnon August 20, 2020
![How can we balance revenue and a social mission without losing our footing?]()
Over the past few months, we have spent a lot of time observing what was happening in our healthcare system and how businesses in the sector were mobilizing. We have witnessed major changes in our system, including the emergence of remote practice and the organization of care pathways across multiple platforms. But we have also seen how this crisis could be a lifeline for some businesses, offering them major opportunities, or, conversely, put them in a highly precarious position.
But one thing is certain: the past few months have highlighted the need to integrate more technology into our healthcare system. And although this kind of innovation sometimes emerges from a public institution, most of the time it comes from private businesses.
Unsurprisingly, to be sustainable, these private businesses need to make sure they generate revenue. But beyond that, they need to keep their employees happy, develop a product that brings value to their users, and more.
Yet amid all the chaos the pandemic has caused, I have encountered different views of private healthcare companies, such as: "Private companies want to make money first, and improve the healthcare system second." Or examples such as those reported in this [article](), which questions a healthcare company's culture.
The statements above reflect a major issue on which private healthcare companies must take a position, one that pits two forces against each other, among others: the need to generate revenue and the need to provide the best healthcare service to the client/patient. The only way to fulfil their mission is to remain competitive in a market where competition is fierce and can come from anywhere in the world.
To better understand this issue, I will first bring it back to a context everyone knows, one that exists even in a world without technology:
## The ethics of compensation in a clinical setting
When I practised as a physiotherapist in a private clinic, I was paid per patient. This meant that the more patients I saw, the more I earned. Which means that, in theory, the best decision for my patient's well-being was not always aligned with maximizing the revenue generated by my service. And this ethical question arises not only for care providers in the private sector, but also in the public sector.
For example, imagine a patient with lower back pain who is progressing very well with the exercises I suggest and has no private insurance. I had to ask myself: does this patient need to be seen twice a week, every week or every two weeks?
Of course, close follow-up every week certainly cannot hurt their progress. But beyond the musculoskeletal condition, I had to ask whether the patient's psychosocial circumstances allowed them to attend every week. I also had to ask my patient about their expectations and needs: did they prefer closer guidance or greater independence? In short, the patient's overall situation should guide the treatment plan above all else.
This is exactly the same issue a healthcare technology company faces, but on a smaller scale and with fewer forces at play simultaneously.
In fact, as a physiotherapist, my professional opinion was never influenced by this need to maximize my income. The treatment plan I offered my patient was, perhaps sometimes at the expense of my employer and my salary, based first and foremost on the patient's needs, financial means, psychosocial circumstances, consent to participate and musculoskeletal condition.
My patient was always at the heart of my decisions.
## The ethics of a private healthcare company
As a healthcare entrepreneur, I believe we should act in exactly the same way. And this way of doing things is called acting with integrity. As business leaders, we cannot loudly proclaim that our mission is to make patients healthier and then prioritize revenue when we are in front of an investor or our board of directors. And I emphasize the word *prioritize*, because revenue obviously also needs to be considered.
We have a responsibility to our clients: to show them that they are right to trust us. That they were right to believe our words and actions were consistent. And ultimately, I believe this integrity has great value, first for the client, but also for the company. It is not only the best selling point and foundation for client relationships you can have, but above all the best way to help society.
To me, this is so obvious that I sometimes wonder: Why are things so often different in large companies? Why don't we put the well-being of the client/patient at the heart of companies' strategic decisions? Why is there so much inconsistency within companies?
Of course, a company's stakeholders are not limited to just two people.
Of course, this idealistic view of business is probably not the easiest route to building a sustainable company.
Of course, sometimes it can seem much easier to set your values aside "just for a while" or to convince yourself that, in the end, what you are doing is still for your client's benefit.
Of course, if you have not asked yourself these questions early in building your company, you may wake up too late.
Of course, doing things properly takes time, and time is limited for a small technology company.
Of course, I may be overestimating the impact of an approach rooted in integrity.
But in the end, I am convinced that it remains the best path for a healthcare company, because our society needs more transparency and integrity. The year 2020 is proof of that.