Small Giants in Healthcare: Why Community-Centered Models Matter More Than Ever

In his book Small Giants, Bo Burlingham challenges a long-standing assumption in business that success is defined by relentless growth, scale, and market dominance. Instead, he highlights companies that deliberately and intentionally choose to be “great instead of big”.  These organizations prioritize purpose, culture, and deep community connections over expansion for its own sake.

This philosophy offers a powerful and insightful lens through which to examine the evolving role of private organizations in Ontario’s healthcare system.

Across the sector, large corporate healthcare models are often built around scale. Growth is driven through acquisition, consolidation, and standardization, with success measured in market share and financial performance. These organizations can bring advantages, including access to capital, investment in digital infrastructure, and the ability to expand services quickly. In a strained healthcare system, these contributions are not insignificant.

However, as Small Giants suggests, bigger is not always better, particularly in sectors where relationships, trust, and local context are central to outcomes. In healthcare, scale can sometimes come at the expense of connection. Standardization, while efficient, often overlooks the nuances of individual communities. Centralized decision-making can distance leadership from frontline realities, and over time, this can create systems that are operationally sound but less responsive to the people they are meant to serve.

Specialty Medical Partners (SMP) reflects a different choice, one that aligns closely with the “small giant” philosophy. Rather than pursuing growth as an end in itself, SMP has built its model around strengthening the clinics, physicians, and communities it partners with across Ontario. It is not about being the largest organization in the room, but about being one of the most effective and trusted.

At its core, SMP’s approach is grounded in partnership. Clinics retain their identity, their leadership, and their deep-rooted relationships within their communities. Instead of imposing a one-size-fits-all model, SMP works alongside practices to enhance operational efficiency, streamline administrative processes, and align with Ontario Health priorities. The goal is not to standardize for the sake of uniformity, but to enable each clinic to function at its highest potential within its unique context.

This reflects one of the central tenets of Small Giants: that enduring success comes from clarity of purpose and commitment to values. For SMP, that purpose is patient-centered care and community integration. Success is measured not only in performance metrics, but in improved access to care, stronger collaboration with hospitals and Ontario Health Teams, and the preservation of trust between patients and providers.

Importantly, this model recognizes that healthcare is fundamentally local. The needs of a community in Northern Ontario are not the same as those in the Greater Toronto Area. Effective care delivery requires flexibility, cultural awareness, and responsiveness.  These are qualities that are often more difficult to maintain within large, highly centralized systems.

Choosing to remain community-focused is not a limitation; it is a strategic decision. Like the companies profiled by Burlingham, SMP demonstrates that it is possible to achieve operational excellence, healthy financial sustainability, and meaningful impact without sacrificing identity or purpose. In fact, these elements reinforce one another.

As Ontario continues to navigate healthcare transformation, the question is not simply how to scale services, but how to sustain them in a way that preserves quality, trust, and connection. The “small giant” approach offers a compelling answer: build strong, locally rooted organizations that prioritize people over size, and purpose over pure growth.

In doing so, organizations like SMP are not just participating in the healthcare system, they are helping to shape a model of care that is more resilient, more responsive, and ultimately, more aligned with the needs of the communities it serves.

Author: Barbara Mekinda, Director of Operations, Specialty Medical Partners

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