TITLE:
Aligning Financial Sustainability with Quality Patient Care through Balanced Stewardship: A Qualitative Inquiry with U.S. Health Care Leaders
AUTHORS:
Emmanuel N. Maseno, Caitlin Byrd
KEYWORDS:
Balanced Stewardship, Value-Based Care, Financial Sustainability, Health Care Leadership, Quality Patient Care
JOURNAL NAME:
Open Journal of Business and Management,
Vol.14 No.6,
November
6,
2026
ABSTRACT: Health care leaders make resource decisions that affect both the financial position of their organizations and the quality of care patients receive, yet some leaders lack strategies to align financial sustainability objectives with quality patient care. This qualitative pragmatic inquiry explored how U.S. health care leaders described that alignment in specific decisions, using value-based care as the conceptual framework. Semistructured interviews with seven leaders across home health and hospice, acute care, academic, long-term care, and safety-net settings were analyzed thematically. This article reports balanced stewardship, one of five themes, which drew on five participants and comprised three subthemes: (a) Quality as a nonnegotiable standard in financial decision making, (b) Return-on-investment logic for clinical investments, and (c) Resource prioritization under financial constraints. Participants described weighing expected clinical benefits against costs, although none of the accounts established a financial return independently. One leader described prioritizing care within staffing capacity set at a higher organizational level. The findings describe reported reasoning rather than measured effects. Practical implications include documenting quality floors, separating measured from estimated costs in investment proposals, making service-line criteria explicit, and agreeing on access measures that prompt review of staffing constraints. The findings may support positive social change by helping leaders protect patient access when resources are limited.