Professionals who operate simultaneously across public and private sectors face unique challenges. These aren’t the same as those who merely consult or switch between them. This dual-system practice involves maintaining a continuous presence under conflicting constraints. Resource allocation systems reward opposing behaviours. Accountability frameworks value different outcomes. It’s about sustained presence in both environments, not compartmentalisation.
The challenge cuts deeper than most realise.
This article examines dual-system practice across three domains – surgical practice, global consulting leadership, and financial services – at individual, firm-level, and institutional scales. As sectors increasingly interconnect through public-private partnerships and hybrid service models, understanding how practitioners navigate these incompatible institutional logics illuminates fundamental differences in how public and private systems shape professional practice.
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When Systems Reward Different Behaviours
Public and private sectors impose fundamentally different constraints. These create genuine operational incompatibilities rather than stylistic variations. In private environments, resources are adopted based on competitive advantage and return on investment. Public systems allocate resources based on system-wide benefit and budget-constrained priorities. Private operations optimise for institution-specific outcomes, whereas public mandates focus on population-level impact.
These differences manifest across various domains. Private hospitals invest in surgical technology for competitive differentiation and revenue opportunities. Public hospitals adopt technology when it benefits population health within constrained budgets. In consulting, private engagements measure success by client-specific transformation. Public policy work measures success by systemic reach and equity outcomes. Similarly, private asset management optimises risk-adjusted returns to investors, while public climate initiatives focus on adaptation outcomes across vulnerable populations.
These resource-productivity trade-offs are universal in clinical practice. They create predictable tensions for practitioners maintaining presence in both environments. Usama Al Bastaki, chair of medical imaging at Dubai Health, notes that ‘The public sector offers robust support for research and education, while the private sector incentivises productivity. Balancing these dynamics ensures that radiologists can grow professionally while delivering high-quality care.’
This tension shapes how dual-system practitioners allocate volume, adopt technology, and structure practice across institutional boundaries. Of course, entire industries exist to convince organisations these incompatibilities can be resolved through better ‘alignment frameworks’ or ‘integration strategies.’ They can’t.
These structural incompatibilities become concrete when individual practitioners maintain clinical presence across both frameworks. The challenge lies in maintaining professional standards that work across both resource environments without optimising for either. This demands practitioners who can sustain regular presence in both institutional settings while adapting workflows to each environment’s constraints.
Individual Practice Across Institutional Boundaries
Maintaining professional standards across incompatible resource environments requires practitioners who maintain regular presence in both institutional settings, adapting workflows to each environment’s constraints. Dr Timothy Steel provides one example of this approach. A neurosurgeon practising in Sydney, he has operated regularly at both St Vincent’s Private Hospital and St Vincent’s Public Hospital since his consultant appointment began in 1998.
Steel’s career totals – exceeding 2,000 brain surgeries, 8,000 minimally invasive spine procedures, and 2,000 complex spine procedures – reflect sustained high-volume throughput maintained across both private and public systems over nearly three decades. Put simply, that’s surgical volume split between institutions with fundamentally different resource priorities and operational constraints. This volume distribution across different institutional constraints demonstrates that dual-system practitioners develop practice patterns independent of any single institution’s resources. The sustained throughput since 1998 shows continuous adaptation rather than episodic cross-sector consulting.
Technology asymmetry presents a concrete operational challenge. At St Vincent’s Private Hospital, Steel operates with access to the NuVasive Pulse digital surgery platform – integrated in September 2022 as the first hospital in Australasia to offer the system. The platform combines neuromonitoring, imaging, navigation, planning, and rod bending into a unified workflow to reduce variability and radiation exposure. Excellence maintained across such equipment divides would seem impossible to anyone who hasn’t tried it. Sustaining surgical volume at St Vincent’s Public Hospital without the same technology infrastructure requires operational adaptation: different equipment configurations, alternative navigation approaches, and adjusted procedural workflows that maintain surgical standards despite resource differences.
Steel’s sustained practice across both hospitals since 1998 exemplifies resource-independent standards – the capacity to maintain consistent surgical volume and outcomes regardless of which institution’s equipment, scheduling, or resource allocation system governs a given case. This form of operational expertise exists precisely because the practitioner doesn’t optimise for either environment’s specific advantages but instead develops approaches that function across both constraint sets. The question becomes whether such individual expertise can scale beyond single practitioners to institutional approaches.
Building Firm Architecture That Spans Sectors
Individual expertise raises questions about institutionalisation. Can dual-system approaches work at firm level? This requires institutional commitment beyond personal portfolio management – building service offerings, practice structures, and expertise configurations that bridge incompatible performance metrics. One approach to this is demonstrated by Bob Sternfels, who leads McKinsey & Company as its global managing partner, directing the New York-headquartered consulting firm’s operations.
Sternfels’ career at McKinsey since 1994 has centred on expanding the firm’s capabilities across digital, advanced analytics, implementation, transformation, and sustainability. These capability domains must serve both private sector clients pursuing competitive advantage and public sector agencies pursuing systemic improvement – client types with fundamentally different success metrics.
In April 2021, Sternfels launched McKinsey’s Sustainability Practice as a dedicated organisational unit. This represents formal institutional investment in capability that bridges commercial consulting and public policy engagement. The practice structure acknowledges that sustainability work requires serving both corporate clients managing climate transition and public institutions designing adaptation frameworks – two client types with fundamentally different success metrics and accountability requirements. Actually, maintaining capability for both client types simultaneously demands institutional resources dedicated to managing tension rather than resolving it.
Sternfels’ roles with the Business Roundtable, Asia Business Council, Fortune CEO Initiative, and New York Jobs CEO Council position McKinsey to engage corporate leadership on sustainability strategy while enabling the firm to remain proximate to climate framework development. This parallel positioning creates capability to translate between commercial implementation and policy design – institutional knowledge requiring sustained presence in both environments rather than episodic consulting to one or the other.
Sternfels’ construction of dedicated sustainability capability demonstrates that dual-system operation at firm level requires institutional architecture designed to maintain presence in both commercial and public policy environments simultaneously. This represents organisational commitment to managing tension between profit-driven client work and public-mandate engagement rather than attempting to resolve that tension into a single service model.
Institutional Leadership Where Finance Meets Framework
Capital deployment at massive scale creates different challenges altogether. When you’re managing nearly $A1 trillion in assets, dual-system practice positions capital deployment at the interface of regulatory frameworks, climate adaptation initiatives, and market-driven investment strategy. One such leader is Shemara Wikramanayake, who has served as Managing Director and CEO of Macquarie Group since late 2018.
Macquarie Group is a financial services institution headquartered in Sydney that manages approximately $A941 billion in assets under management across 31 markets worldwide. It provides clients with asset management, infrastructure investment, banking, and advisory services across global markets. This commercial mandate operates under fiduciary performance requirements and risk-adjusted return optimisation.
Concurrent with leading Macquarie’s commercial operations, Wikramanayake serves on the World Bank’s Global Commission on Adaptation and participates in the United Nations Climate Finance Leadership Initiative. These roles position her at the development of climate adaptation frameworks and sustainable finance policy while simultaneously managing institutional capital deployment through Macquarie’s asset management operations.
The institutional knowledge required to deploy capital in alignment with emerging climate frameworks while meeting commercial performance standards represents dual-system expertise at an institutional scale. What does ‘institutional knowledge’ actually mean when you’re operating pools of capital this large while simultaneously shaping the climate frameworks that will govern them? It’s understanding regulatory development before it’s finalised while maintaining fiduciary responsibility to current investors. Wikramanayake’s parallel leadership of commercial asset management and engagement with public climate policy initiatives demonstrates institutional-scale dual-system practice – positioning capital deployment at the interface where public framework development meets private investment strategy.
This generates reciprocal influence unavailable to single-sector leaders: commercial insight informs public policy frameworks, while proximity to policy development enables early positioning for climate finance opportunities. Strategic advantage emerges specifically from maintaining presence in both environments rather than choosing commercial performance or policy influence.
Why Contradictions Don’t Resolve
Across individual surgical practice, firm-level consulting capabilities, and institutional financial leadership, a consistent pattern emerges: dual-system practitioners don’t resolve tensions between public and private sector logics into unified approaches. Steel doesn’t develop a single surgical protocol optimising both private hospital revenue and public hospital resource constraints. Sternfels doesn’t merge commercial consulting and public mandate work into one service model satisfying both client types equally. Wikramanayake doesn’t reconcile commercial asset management metrics with public adaptation priorities into a single performance framework. Sure, entire industries of policy institutes and consulting firms keep trying to ‘bridge’ these systems with unified frameworks, but decades of evidence shows the tensions are permanent features, not bugs.
The operational incompatibilities are structural rather than superficial. Private systems reward efficiency, volume, and institution-specific outcomes. Public systems reward equity, access, and population-level impact. These aren’t merely different emphases on the same objectives – they represent genuinely incompatible optimisation targets where decisions maximising private sector performance often violate public sector mandates and vice versa.
Rather than representing failure to achieve integration, persistent tensions generate the distinctive expertise of dual-system practice. Steel’s capacity to maintain surgical standards across different technology infrastructures emerges directly from refusing to optimise for either hospital’s specific equipment. Sternfels’ Sustainability Practice capability to serve both commercial clients and engage public policy emerges from maintaining separate performance expectations rather than blending them.
Practitioners operating exclusively in private environments develop deep expertise in optimisation within that system’s constraints – maximising revenue, competitive positioning, institution-specific metrics. Practitioners operating exclusively in public environments develop deep expertise in equity, access, and population health outcomes within budget constraints. Dual-system practitioners sacrifice depth of optimisation in either environment to develop breadth of adaptability across both – a different form of expertise.
Trading Optimisation for Adaptability
Dual-system practice demands continuous tolerance for operational inefficiency as every decision represents partial compromise rather than full optimisation for either environment. Traditional business education and efficiency consulting revolve around optimisation for single objectives, yet here’s deliberate maintenance of partial compromise as operational strategy.
This perpetual compromise extracts cognitive and operational costs: practitioners must constantly evaluate which constraints to prioritise in each decision while knowing full optimisation remains impossible.
Yet practitioners examined here sustain this approach over decades: Steel since 1998, Sternfels since 1994, Wikramanayake leading Macquarie since late 2018 after joining in 1987. The duration suggests that despite operational costs, the strategic advantages of cross-sector expertise justify sustained inefficiency for these practitioners.
The Challenge of Dual-System Practice
The professionals examined here succeed in dual-system practice not by reconciling public and private sector logics but by extracting advantage from their fundamental incompatibility. The expertise they develop – resource-independent surgical standards, institutional capabilities that bridge commercial and public mandates – exists precisely because these practitioners maintain operational tensions rather than resolving them.
Dual-system practice reveals that public and private sectors shape professional practice through genuinely incompatible constraints rather than merely different emphases. The strategic advantage of simultaneous operation comes from developing adaptability across both constraint sets while accepting perpetual optimisation failure in either environment alone.
As institutional boundaries continue blurring through hybrid funding models and sector-spanning mandates, more professionals will face dual-system demands. The sustained presence under conflicting constraints that these practitioners have maintained for decades isn’t just operationally demanding – it’s cognitively exhausting. Most professionals can’t sustain it. Those who can develop a form of expertise unavailable to anyone optimising for a single system’s rewards.
