Many/most businesses run Windows without issue. What matters is having a competent IT department to manage only the updates that are necessary and have suitable protections to ensure nothing else clutters-up the system. It helps also to have software that's fit for purpose, properly integrated and fully supported by its developers.
If the commercial sector can do this there's no practical/technical reason why the public sector can't either....
It can get a bit complicated. What has tended to happen historically is this:-
IT Director: We are going to upgrade all workstations to Windows 10
Most people: Hooray!
Clinician 1: Will the system that we use for sending X-Rays work on it?
IT:; Er... No. Looks like we still need Internet Explorer 11 for that and WIndows XP.
IT Director: We are currently carrying out a compatibility review as it has been highlighted that some key clinical functions may not work under WIndows 10.
IT: <starts going through vendor warranted environment specs> Contacts vendor - we need to upgrade this system to be compatible with Windows 10.
Vendor: Well it isn't. We hadn't planned to do that.
IT: <starts procurement of new system>
IT Director: I am pleased to announce that all workstations are now running Windows 10.
Most people: But we are all on WIndows 18 now!
Although notably all the hospitals I worked in bypassed Vista entirely and went from Windows XP to Windows 10/11 with nothing in between. Maybe the odd Windows 8 machine for a Director level bod making a fuss.