The Business of Healthcare: An interview with Caroline Bates

Caroline Bates has worked in the NHS for 13 years. Today, she is the Associate Director for Nursing for Medicine, Cancer and Emergency Care at Darent Valley Hospital.

I met Caroline when I was studying for my MBA and am always really struck by how she takes the huge responsibility of her job in her stride.

Here's what the amazing Caroline had to say when I asked her about the many aspects of her role.

Caroline: It’s really difficult to say because you can’t predict the NHS. I’m responsible for delivering the quality standards within the clinical care group. I manage a set of key performance indicators, things like rates of pressure ulcers, complaints and more. I also look after the emergency department (ED). The job can be very reactive. I might have meetings booked, but then someone’s at the door with challenges that I need to address.

I manage lead nurses, matrons and governance leads. But obviously I’m responsible for all nurses, healthcare professionals under my clinical group, which is hundreds!

Caroline: Inside the organisation, it’s everyone from the executive and operational colleagues to colleagues in the multidisciplinary team. Externally, I’ve presented to the Care Quality Commission (CQC) and I’ve had visits from the Clinical Commissioning Group (CCG). We’ve got quite an open, transparent relationship with them, which makes it easier when it comes to regulation and inspection.

Caroline: I look after quite a substantial amount. I’ll do finance clinics with the finance manager, and then I’ll sit with the Matrons and Senior Sisters and roll through their budgets. Within medicine, for example, we look after about £1.2 million.

Caroline: I can’t say that I view it as a business. Obviously, you’ve got to look at your income, your revenue, customer, patient experience, all of that sort of thing. But I don’t see them as customers. I see what we do as a duty of care. Our Associate Director of Operations is a non-clinical post and does the business side of things.

Caroline: I’d say delivering the ED constitutional standard. You need to make sure that the balance is right between discharge at the back door safely, but also not having a significant risk to patients who are in ED waiting for a bed. That can be very difficult on a daily basis and challenging.

The other challenge is probably managing individual behaviours. There are HR issues on a daily basis, which obviously have to come to me to be addressed and actioned.

Caroline: I say to all my matrons and nurse: “I don’t want you here past your hours unless you’re absolutely concerned about an area”. I’ve been in the position before where you’re doing everything, you’re trying to pick everyone else up and you just end up drowning. Absolutely no disrespect, but if you die tomorrow the NHS will carry on. I’m a lot more strict with myself now than I ever was. You need to set that precedent.

I’m also very fortunate that my husband takes the kids to breakfast clubs in the morning for their school. Our parents do a lot of pickups from school. I could not never work. I think I would go a little bonkers!

Caroline: Communication without a doubt! It’s also important to have that clinical credibility, so my staff don’t see me as a senior nurse in an ivory tower. I still do bank work so that I can say: “I know what it’s like when you’re short staffed and I know what it’s like when you’re really busy with loads of confused patients”. I think the team responds well to that.

Leadership is also really important. Some people get things done by being quite blunt and forceful. I do it by being a support mechanism.

Caroline: It’s massively helped me. Before I was very linear with my thinking so it has definitely helped me to develop. For example, in ED where we’re looking at the streaming, triaging and workforce modelling. I’ve been running the PDSA (plan, do, study, act) cycles where we look at how we are doing and then tweak. A lot of the staff had never thought like that and a lot of this thinking comes from the MBA.

It gives you that broader view. It develops the way you speak, the way you hold yourself, the way you present. It’s to do with confidence and people believing in you and giving you those opportunities as well. So that’s what I always try to do with my staff.

Caroline: I suppose budgeting. You’re not taught that when you go to be a nurse. You learn it on the job. The MBA obviously helped – I remember sitting in revenue, tax, capital blah blah blah thinking: “what on earth?” I learnt quite a lot very quickly within the two-year period around money.

Caroline: If I’m not convinced, I think: ‘what is it that’s niggling at me?’ Sometimes your values and objectives don’t match organisation’s, but actually you are working for that organisation so you are meant to have a common goal. There are five of us in the senior nursing leadership and we’re really clear that at no point must quality be compromised to make efficiencies.

Caroline: We’re getting there: doing the vital signs by the iPad, getting the e-prescribing on board so we can go paper light and then paperless. I’m really data hungry. I like people to feed me data so I can see and track how we are doing against our benchmarking.

Caroline: Actually it’s a website: the Health Foundation. The documents that they produce are just fantastic. You can go on there, you can get them sent to your house for free or you can read them online. It just keeps you so up to date.

I always say, it’s good to be in the know, and to know what’s coming before it hits you. So the 10-year plan document that has come out has also been my focus at the moment.

Caroline obviously bares a huge amount of responsibility every day. I really think that her attitude around that is great. She seems to really protect her team and not set bad examples by working every hour. And, when she talks about her colleagues at a leadership level, it's clear they all know they're going in the same direction. I really believe that, with a solid, united and trusting team, it's a lot less daunting to take on responsibility.

Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the only consultancy to have worked with 11 Training Hubs across South London, Kent, Surrey and Sussex.

Tara and her team also work with GP federations supporting the implementation of clinical services.

Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 100 blogs.