Why Sandhya J is Betting on Lean Healthcare to Drive Sustainable Growth at Narayana Health
By Arunima Rajan
In a healthcare sector where leadership continues to be dominated by men, Sandhya J, Group CFO of Narayana Health, brings a distinct clarity and strategic edge to the table. As one of the few women steering a major Indian hospital chain, she is not merely balancing budgets she is redefining how finance can serve both purpose and progress in healthcare. “It’s not just important, it’s mission-critical,” she says. With rising input costs and mounting pressure on reimbursement models, she believes that staying lean and frugal is essential to keeping care accessible to the majority of patients in India.
But frugality, in her playbook, is not about cutting back it’s about thinking forward. It means investing in robust digital infrastructure like Athma, Narayana Health’s in-house hospital information system, and Medha, its AI-powered analytics platform, both of which enable smarter cost management and better clinical outcomes. It also means deploying data to streamline operating room schedules and supply chains, ensuring that every asset is used wisely. Under her leadership, this disciplined approach has evolved into a strategic strength. It keeps the organisation nimble, enables continuous innovation, and reinforces the belief that affordability and excellence in healthcare are not opposing goals, but complementary ones.
You trained as a Chartered Accountant and now helm the financial engine of one of India’s most ambitious hospital chains. Could you walk us through the invisible journey—what shaped your thinking, your approach to work, and how your perspective on healthcare evolved over the years?
My journey has been less about milestones and more about mindset. I began my career at Hindustan Unilever and then progressed onto Wipro. Through my career, I was fortunate to experience the breadth of finance supply chain, business partnering, shared services, IT, project management, and controllership. In addition to these being great institutions for learning, I also feel it is important to bring intentionality to every role staying connected, making each experience count, and ensuring my work left a visible imprint that truly shaped me.
I also believe in tenure not just staying long enough to do the job, but long enough to embed yourself in a company’s ecosystem. Understanding its undercurrents, values, and leadership patterns takes time. Belonging isn't a transaction; it’s built. Yet within that stability, I’ve always sought diversity new roles, fresh challenges, or carving out niche experiences in existing responsibilities. An early mentor asked me to create a “career wheel” not just titles, but the experiences I wanted to accumulate. That wheel has guided me for years. Even when I couldn’t formally tick every box like for ex: a full-time tax role I sought those learning moments wherever they arose, taking on tax projects with depth and rigor.
As for healthcare, it’s an industry poised for reinvention. Today’s care model is largely episodic patients come when they’re sick, and we solve for that moment. But the future must be longitudinal. Think of how Amazon sees your lifetime value across Prime, Audible, Shopping. Healthcare too must evolve into a platform of continuous value across the patient’s journey. And the challenge for finance professionals like me? To model this kind of nonlinear, long-horizon thinking into outcomes the business can actually act on.
At Narayana Health, frugality has always been a strategic strength. As CFO, how do you walk the tightrope between cost-efficiency and quality care in a sector where the stakes are deeply human?
1. Purpose as the North Star
At Narayana Health, our foundational mission is clear: to make high-quality healthcare accessible and affordable for all. This commitment to purpose permeates every facet of our organisation, fostering a culture where innovation thrives. A prime example is our pioneering 'factory model' for cardiac surgeries, which standardises procedures to enhance efficiency without compromising patient outcomes. By aligning every team member to this shared vision, we've cultivated an environment where cost effectiveness and excellence in care coexist harmoniously.
2. Digital Transformation: Automating for Impact
Our journey toward automation is integral to achieving our mission. Through our state of the Art Hospital Information System (HIS) - Athma, we've integrated advanced digital solutions across our operations. The AADI app, for instance, serves as a digital assistant for doctors, facilitating real-time communication and providing instant access to patient data. This tool has significantly reduced administrative burdens, allowing clinicians to dedicate more time to patient care. These innovations not only enhance operational efficiency but also elevate the quality of care we provide.
3. Data-Driven Decision Making
Data is at the core of our decision-making processes. Our AI powered analytics platform, Medha, offers real-time insights into various operational metrics, enabling us to make informed decisions swiftly. For example, Medha's predictive analytics capabilities help us manage pharmaceutical inventories, enhancing asset utilisation rates without compromising patient safety. By embedding data analytics into our daily operations, we ensure that every financial decision aligns with our overarching goal of delivering affordable, high-quality healthcare
Financial strategy in healthcare isn’t just about numbers—it’s about people, policy, and unpredictable events. What are the hidden factors that most people miss when they think about hospital finance?
Hospital finance is not just a spreadsheet exercise—it’s a delicate balancing act between today’s realities and tomorrow’s ambitions. On the one hand, we are deeply focused on operational efficiency, cash flow discipline, and profitability. These are non-negotiables in a sector where sustainability directly impacts human lives. But on the other hand, financial stewardship in healthcare also demands imagination—the ability to carve a strategic path forward. That means making deliberate choices to reinvest today's surpluses into tomorrow’s growth engines. At Narayana Health, we’ve channelled resources into our integrated care business, which we believe represents the next frontier of value-based healthcare. This shift—from episodic treatment to continuous engagement—requires new operating models, new capabilities, and a new kind of financial architecture.
What’s often invisible to the outside world is the simultaneity of it all you're optimising current operations while incubating long-term transformation. You’re accountable to the present, but answerable to the future. That’s the paradox and the privilege of financial leadership in healthcare.
The pandemic was a test of resilience for healthcare institutions. What were the most difficult trade-offs you had to consider during that time—both as a professional and as a person?
I joined Narayana Health at the tail end of the pandemic, so I wasn’t on the frontlines of those decisions. But I continue to feel the reverberations of the choices the organisation made during that period—choices that revealed its character more than any financial metric ever could.
At a time when uncertainty loomed and commercial pressure was immense, Narayana chose to lead with purpose. Patient care and employee safety were placed firmly above profitability. We voluntarily administered vaccines at cost, long before it became a policy mandate. We delivered high-quality COVID care at significantly subsidised rates, even when the economics didn't add up because we knew the country needed that intervention.
The result? While some healthcare organisations emerged from the pandemic with healthier balance sheets, Narayana emerged with something far more enduring: credibility, trust, and loyalty. We came out rich in the currency that truly matters—our reputation with patients and our bond with employees. That trust wasn’t built during a quarterly review; it was forged during a national crisis. And it continues to serve us every single day.
Hospitals across the country seem to be in expansion mode—adding beds, specialties, and new geographies. Is Narayana Health also planning for growth? And how do you balance ambition with financial prudence?
Yes, we are expanding we’ve formally announced the addition of 2,000 beds over the next four years, and more projects are under consideration. But at Narayana Health, growth isn't defined by the number of beds we add. A bed is not a performance metric it’s a delivery mechanism. Our real focus is on capability-building, and on reshaping how healthcare is accessed, experienced, and trusted.
We’re asking ourselves: what does value look like from the customer’s lens? That question drives every strategic decision. Our foray into insurance, for example, isn’t just a business extension—it’s a response to the long-standing trust deficit between payers and providers. We believe integrated care models can rebuild that trust by aligning incentives and outcomes.
Our Aarogyam initiative aims to reduce the healthcare burden on families by shifting the focus to prevention and early detection because value isn’t just about what happens inside the hospital, it’s also about what you can help avoid. And with the NH Care app, we’re putting electronic health data directly in the hands of patients, enabling them to move freely with their health records an act that is as empowering as it is overdue.
So yes, we are building capacity. But more importantly, we are building a future-ready healthcare ecosystem, one where value to the customer is the only true north.
Women leaders in finance remain rare, particularly in Indian healthcare. Have you ever found yourself underestimated in boardrooms? How did you respond—quietly or otherwise?
I’ve been fortunate. At Narayana Health, I’ve always felt respected and valued for what I bring to the table. I have a strong voice, and I’m trusted with responsibilities well beyond my immediate mandate. This has been true across much of my career I’ve had the space to grow, to contribute, and to lead meaningfully.
But I also recognise that my experience is not the norm for many women. Too often, I see talented women hesitate to speak up, to claim space, or to invest in their own growth. They may downplay ambition, defer upskilling, or view their careers with hesitation rather than conviction. And that’s a loss—not just for them, but for the organisations they’re part of.
Healthcare is an especially stark example. While the overall gender diversity in the sector is encouraging—often over 50%—the number of women in leadership roles remains painfully low. That’s not just a pipeline problem; it’s a mindset issue. And it needs attention on both sides. Organisations must create enabling environments, yes—but women must also step forward, build the ambition muscle, and own their trajectory. Progress here will come only when we see it as a two-way journey—where systemic change meets individual empowerment.
With digital health, insurance dynamics, and real-time data now part of the financial landscape, what new questions are you asking today that you weren’t, say, five years ago?
They say data is the new oil but in healthcare, I’d go a step further: data is the lifeblood of the system. It pulses through every function from diagnostics to decision-making and when it flows smoothly, the whole system thrives.
One of the most transformative shifts we’re witnessing today is the explosion of innovation in diagnostics. For non-communicable diseases like cancer, diabetes, and heart conditionsb prevention is no longer a luxury. Early detection is the only viable path. An early-stage cancer can be treated with minimal intervention; a late-stage diagnosis is a vastly different, and far more complex, story.
So the big question we’re asking ourselves now is: how can we bring together insurance, digital health, and clinical intelligence to proactively keep people healthy? How do we move from a reactive model treating people when they’re sick to a proactive one, where we prevent illness before it starts?
Finance has a vital role to play here, not just in funding innovation, but in reimagining affordability and access. With the right digital infrastructure and insurance frameworks, we can scale care to a much broader population. But it requires us to build systems and solutions that are fit for this new paradigm—ones that are predictive, personalised, and seamless across the care journey.
That’s the future we’re building toward: one where healthcare is not episodic, but continuous; not reactive, but preventative; and where finance is not just about managing costs, but about enabling transformation.
What kind of leadership do you admire in others? And what personal habits or values have helped you stay grounded in such a high-stakes role?
Right now, I can honestly say I’m having the best time of my career working under the leadership of Dr. Devi Shetty. His sense of purpose is deeply inspiring. His ability to envision the future of healthcare is unmatched he’s already thinking twenty years ahead about how care should be delivered, how it should be accessed, and how technology can be used to democratise it. But what truly sets him apart is his humility
and openness. Despite his stature, he makes space for every voice in the room. He listens, encourages debate, and brings people into his vision in a way that feels deeply personal. To work alongside someone like that it’s a dream come true.
On a personal level, the habits that keep me energised. First, honesty I speak my mind. I believe in transparency, even when the truth is uncomfortable. Second, I’m always pushing boundaries. I constantly ask myself: What lies beyond this solution, this outcome, this assumption? Why not more? And perhaps most importantly, I’ve learned to have the humility to accept when I’m wrong. And I know there are so many places I am still wrong. To reflect, learn, and try to be a better person the next day. None of us are perfect we're all works in progress..
Lastly, if you could send a quiet note to your younger self at the start of your career, what would it say?
“Take your health seriously. Don’t leave it on the backburner.”
Through the early years of my career like so many of us I poured all my energy into work. Long hours, travel, intensity. I told myself that the late-night meals, skipped workouts, or general neglect were just the cost of ambition. That they were rewards, even, for how hard I was pushing.
But moving into healthcare changed me. It made me see the value of health in a visceral way. I’ve since placed my own well-being back on the radar not as an afterthought, but as a priority. And I’ve realized something important: I’m not getting less done—I’m just prioritising better.
It’s a virtuous circle. The more you care for your health, the more energy you have. The more energy you have, the more you give to your work, your family, your life. Everything becomes lighter, more joyful, more alive.
So yes, if I could whisper one thing to my younger self, it would be this: ambition is powerful, but vitality is what makes it sustainable.
Got a story that Healthcare Executive should dig into? Shoot it over to arunima.rajan@hosmac.com—no PR fluff, just solid leads.