Guest interview, Tony McLean tells us about his experience working in Healthcare

Tony, firstly can you tell us a bit about your career to date?

I am a registered nurse by professional background and trained in General Nursing, Psychiatry and Health Visiting which has always given me a wide perspective in healthcare. I suppose it was this grounding that allowed me to progress quickly up the general management tree once I stepped into healthcare management. I worked as a Provider General Manager and a Commissioning Manager before moving into Director roles. I worked my way up the NHS management system to become a Trust Chief Executive by the time I was 36 years old.

After several years as a Trust CEO, I left the NHS and worked for five years out of healthcare while I ran the biggest PFI project in Europe; an MoD PFI with a value of £2billion and a £600 million construction contract at the centre of it. I returned to healthcare but into the dark side, as my NHS colleagues would put it, as I entered the independent sector and I have been here ever since. I really enjoy working with private equity and private investors and have taken the opportunity to become an investor myself.

Why did you decide to become an Interim?

A new contact of mine is a turnaround specialist - Ian Gray, Chairman of Baronsmead - and he knew I was coming to the end of my time in one of my businesses and so asked if I would join him on a project to stabilise - and then sell - a business he was working in with the banks. This was a really interesting project and I enjoyed working with a new team and bringing about changes to the business and to the management style. We stuck to a tight timescale and completed the sale of the business to the satisfaction of the bank and investors. This process really whetted my appetite for turnaround so I began to look more actively for this type of opportunity.

You’re pretty new to the world of Interim so how have you found the move?

The transition to interim has gone well as it is just about deploying your skill set in different ways. The need to be clear and concise has always come easily to me as a product of my nursing background. Good project management skills gained in the PFI industry also means that I can – with a team - map out what needs to be done, by when and what the sensible milestones are for delivering the outcomes needed. I think teams who recognise that they need interims are always receptive to this type of approach. I guess they are also hesitant as they know change is coming down the line, but if you are skilled at managing communications with people then you can soon put them at their ease.

What do you consider to be your core specialisms?

I am a healthcare specialist at heart and I love nothing more than improving the quality of care for people we are tasked to look after or support; our patients and clients. My other main attributes are that; I communicate effectively and concisely; I have the ability to think out of the box and bring about changes for the better - certainly in the medium to long term; I provide leadership through change processes and because of my professional background I think I am approachable which makes life much easier. I also think I manage other professions well, not just clinical professionals but accountancy and support services too; and I have a consistent temperament which those who have worked with me say is a good quality - especially in turnaround and interim work.

Why did you choose to become an Interim?

I like the immediacy of interim work as you are empowered to make changes and bring about improvements in services, as this is your key mandate in most cases. The state of the independent sector today has meant more services are in need of change - either financial change through restructuring or structural change to meet the new and shifting agendas so I want to be part of that. I also think my breadth of knowledge and experience means that I can steer through a problem much easier than most, as I may have encountered the same or similar problems elsewhere.

The Healthcare sector – both NHS and private - has evolved over the past 10 years so what do you think are the main challenges for the market right now?

I think that the NHS is beginning to realise and accept that the independent sector can match it in terms of skills and quality in more and more sectors of healthcare. The independent sector has been heavily regulated for a long time, so the NHS can learn a lot from those of us who have had that sort of scrutiny and have had to redesign services to meet the changing demands. Foundation trusts more and more will need to have this as part of their armoury of skills and will benefit from those of us who can assist their turnaround.

The NHS is a large and unwieldy beast at times and suffers from too many changes in direction that are politically motivated rather than responding to the needs of the population we serve. So much change in such a large organisation means that just as it gets to grips with one set of changes it has to start to consider the next, as the rules are changed. There is never any stability which has a direct impact on quality of care and patient/client safety. Independent sector specialists are used to reacting quickly as the decision processes are much shorter and what can be agreed at Board today can be enacted tomorrow, without long consultation or deliberation.

There also needs to be greater co-operation between the two sectors to achieve targets and both sides need to be less precious about the boundaries. For instance, the independent sector could help to solve the bed blocking problems of acute hospitals, if only the commissioners would allow it to have meaningful dialogue and were less perturbed about it making a profit. Those of us with senior experience in the health service and the independent sector can offer a great deal to both sides by bringing about efficient and effective change to meet today’s growing agendas.

On the flip side, what do you think are the main opportunities?

I think with advances in technology and the development of more non-hospital based care, there are lots of opportunities to manage care in a different and non-traditional way. The independent sector has innovated for many years in this style of service development, so has a distinct advantage going forward. The NHS needs to look at grasping some of these innovators, particularly in the Foundation Trusts and utilise the skills in leadership and the development of service offerings.

How have these affected your own career?

Being out of healthcare altogether for five years really helped me gain a new perspective when I came back to it. My time spent in the PFI industry gave me additional tools in project management, finance and investment that have been invaluable. The shift away from traditional healthcare has meant the independent sector - especially in the specialist areas - have gained a march on the NHS which could be unassailable going forward.

Can you see what you do changing in the short to medium term?

The need for interims is now long term and is part of the normalised infrastructure; not just a need for times of austerity. I think businesses and industries have always had this type of manager in the system but often known by other names such as change agents, innovators, trouble shooters. I think the periods of time that interims are in a service will grow, as they will be seen as the stabilising influence as well as the force for change and this will be a really exciting development for me.

What do you think are the main benefits for an organisation that employs Interims?

The benefit of buying in experience and people who work quickly is to bring about change and refocus the services. People who they may not otherwise be able to recruit into the organisation on a long terms basis can come in, assist and then back out again giving the best of all worlds. Also, clear project accountability and timelines that are defined at the outset with some specific deliverables are key. It’s important to not dilute the existing resource, so it can allow the established systems to run until the change is planned and finally implemented

Do you think those benefits are different in the private and public healthcare sectors?

The private sector is more accustomed to changes occurring quickly, as the decision tree is much smaller. Discussions can reach a decision today and be enacted tomorrow if needed which gives a level of immediacy that does not exist in the NHS or wider public sector. The public sector approval route is long and arduous - especially if you have to go through the business case approval process which can take literally years. The use of interims can often expedite matters as they will innovate and avoid the need for costly and timely processes. I think there is an expectation that interims are more ruthless (as they are often used out of necessity) and so people are less resistant to the changes they make as there is almost a deemed acceptance that they will happen. Finally, any words of advice for readers of Perspective who may be thinking of becoming an Interim? Chose a good partner to have when becoming an interim and make such you use an agency or placement service you can trust and that clients are likely to trust. Research those agencies fully before making a decision; don’t be afraid to be specific about what it is you want; don’t be afraid of asking for advice as no one has all the answers; find a mentor in the system if you an unsure and remember the five P’s (six if you’re in the Army!!! But too rude for here) i.e. Preparation and Planning Prevent Poor Performance

Finally, remember that we work to live not live to work so make sure you get the work life balance correct or you will burn out quickly. That’s not to say don’t work long hours as we all do that, but find something outside of work, such as family, friends, relationships, sport or hobbies, that allow you to switch off. In short, work hard play hard!

For more information on Tony, please visit his Linkedin page.