The Perils of Empire Building in the Canadian Health Sector: The Case for Consolidated Vision through Diversified Investment

In the landscape of not-for-profit and charitable work stakeholders should unite with one mission: addressing social needs with the most appropriate, timely, and impactful approaches possible. Yet, a trend has emerged that detracts from this core objective. This trend is "empire building"—a practice that encourages expanding reach, often at the expense of focused expertise needed to create lasting change. Empire building, while promising greater influence, risks scope creep, lacks expertise, and inefficiently consumes resources, often hindering more contextualized solutions with real impact.

Scarcity Mindset - Inhibiting Equitable Approaches

Large organizations are holding and retaining power and influence over health system design and investment. We see examples of this happening in research, direct service, and intermediary spaces where individual organizations are operating with good intentions, but scarcity mindset perpetuates siloed working and empire building. For example, with larger organizations playing a critical role in areas like advancing health research we see funding processes and priorities that are set by these larger agencies favouring established institutions and individuals. This limits the ability to decolonize research and build equitable evidence across the country.

The emphasis on large-scale research projects or specific areas of focus can lead to a concentration of resources in particular domains, which often means our most critical health research needs are sub-items amongst more generalized research topics. This can create an environment where smaller equity-serving organizations struggle to thrive, potentially stifling diverse approaches to research and innovation.

The risk to equitable forms of expertise and service delivery becomes real as large organizations can monopolize the voice of the health sector. Without the specialized skills and topic expertise of smaller organizations homogenization of service offerings can occur. To mitigate against this impact of scarcity mindset we can utilize the platforms of larger organizations to amplify the impact of smaller groups and promote localized investment.

Resource Drain: Inhibiting Nuanced Solutions

Empire-building also tends to monopolize resources that could otherwise support more tailored, locally driven, and effective solutions. Larger organizations with broad portfolios often pull in significant funding due to their perceived impact across multiple sectors but a substantial portion of these funds offset operational costs, marketing, and overhead, leaving less for targeted, grassroots interventions that smaller, more specialized organizations deliver.

This resource drain is problematic. When large organizations compete for resources across multiple sectors, they limit the funding available to more focused groups that could create more precise, adaptive solutions. These smaller organizations, often deeply embedded in their communities have the local expertise necessary to respond to targeted needs.

The Missing Key - Lived Experience

One of the critical issues with empire-building is the undervaluing of lived experience. As organizations expand, the gap between those providing services and those receiving them can widen. The further removed organizations become from realities in communities, the less likely they are to deliver solutions that meaningfully address the needs of the communities they serve. Decisions made by individuals without direct experience in navigating the issues they seek to address are often out of touch with need, lacking the nuance and empathy that lived experience brings.

Charities and nonprofits would better serve their mission by fostering leadership and staff with lived experience, enabling decision-making grounded in firsthand understanding. By doing so, organizations avoid the pitfalls of “parachute solutions” and focus instead on deeply informed, community-driven efforts that foster sustainable change.

Ehat’s next

We have seen this cycle of well intentioned, weakly impactful investment in most health specific and adjacent sectors for decades. In recent years this is furthered by an almost frenetic approach to finding and investing in “saviour solutions”, models, initiatives or programs that are touted as solving complex health challenges that in practicality require diversified responses supported by multiple groups.

To counteract the detrimental effects of empire-building, the charitable sector can shift towards specialization, collaboration, and community-driven leadership. Empowering smaller, locally embedded organizations with the resources they need to succeed is a crucial step toward a more effective charitable landscape. Ultimately, the charitable sector can better serve its mission not by growing larger but by growing smarter, embracing depth over breadth, and championing localized, empathetic, and sustainable change.