Yes, Milton Friedman's idea that a business's social responsibility is to make profits is more complex with today's social responsibility standards. However, in Friedman's analysis, he believed that executives should return as much as possible to the shareholders of the business and that return on investment is best spent on distributing scarce resources for social goodness (Friedman, 1970). However, as he also noted, shareholders and business leaders are not equipped to make such decisions, which I believe is why our social programs are not as robust and resilient. For example, I worked for a non-profit with a board of invested interests in the organization's mission and profitability. When it came time to renovate the building where the business was conducted, the board was split. Half the board wanted to spend money toward offering charity programs, and the other wanted to spend the money on updating the center to attract more self-pay clients who paid more for services. The decision was cyclic, constantly moving from the mission to the profitability to fulfill the mission, so the renovation plans took over three years (not uncommon and much faster than in some other non-profits). For hospital systems, in the last ten to twenty years of acquisitions and mergers mounting in millions of dollars, it seems that the business of healthcare is primary.

In contrast, actual health care seemed a secondary matter until CMS (Centers for Medicare and Medicaid Services) pushed value-based reimbursement over the old fee-for-service (CMS, 2023). This reimbursement change is at odds with a hospital's profitability; thus, pivoting with a new strategy to increase profits is vital for most hospitals. Social responsibility investing has increased hospital profits and other businesses' profits considerably, thus attracting more clients and patients and even promoting a cultural shift toward social responsibility, which I support (Tepper, 2020).

I could go round and round as I know the value of my education and what I want to be reimbursed at the rate I am worth, yet I also know my responsibility to humanity and the common good is the utmost goal of my calling. What does this mean? More than likely, I will work back in the non-profit world with these conflicting ideologies but with a culture uniform in care and health equality that I can stand beside.

Warmly,

QUESTION

• Offer an insight you gained from your colleague's analysis of how strategy helps business leaders focus on "the big picture."
• Relate to something your colleague identified about which aspects of culture are most critical to the development and execution of business strategy.
• Provide an additional perspective on your colleague's analysis of whether it is beneficial for an organization to base its strategy on being mission driven or purpose driven.