A brilliant clinician steps into a leadership role. Alongside their clinical expertise, they’re now expected to retain staff, manage resources, understand financial performance and identify opportunities to improve the business.
But where do those skills come from?
For Change2020 director and executive coach Kerryn Fewster, this is a skill set gap aged care providers need to address, sector-wide.
“We’re asking these people to bring everything that makes them a brilliant clinician into a leadership role,” she says.
“And it’s so often we see, oh, you’re a great clinician, but we didn’t educate you on leadership, of which commerciality is a part.”
Fewster, whose work spans aged care and other industries, says some leaders still wrestle with whether being commercially astute belongs in a care environment.
“What we would say is it’s not only okay, it’s a foundational piece of leadership.”
A commercial lens on care
Fewster sees commercial thinking as essential to a provider’s ability to keep investing in residents’ lives.
That investment extends across the whole experience: quality food, well-maintained grounds and a home people feel proud to invite their families into.
“They deserve to be able to feel proud of their house they live in and the restaurant they attend.”
Understanding the “cost to serve” helps leaders recognise where resources are going and what could be done differently. The point is to connect commercial decisions with the experience they enable.
Understand the cost of leadership
Staff retention can represent a tangible example of that connection. “It’s about understanding that if I am a better quality leader, I’m likely to retain my employees, which means I don’t need to go and find contract staff all the time, which costs more.”
Repeated recruitment and onboarding also affect continuity and the resident experience. Fewster says leaders need awareness and understanding of those consequences. “So give them information around turnover, show them what it costs to onboard somebody, give them the cost of the contractors if they’re trying to reappoint people.
For providers, this means helping managers understand how their leadership contributes to both workforce stability and financial performance.
Leaders own the numbers conversations
Fewster’s practical starting point is giving site managers access to their numbers each month, and the skills to understand them. “They actually drive the conversations with the finance team as opposed to the finance team coming and showing them.”
That means recognising an unusual expense, questioning rising contracting costs or investigating why an apparent saving isn’t carried through in broader trend data – whatever is required at that moment in time.
Financial information should sit alongside feedback from residents and families. Fewster says a manageable number of measures can help leaders understand costs and experience without overwhelming them with data.
The aim is to move beyond reporting that a service is simply over budget with hands in the air, towards explaining what is driving the result and what actionable change is required.
Make room for the “one percenters”
Fewster also encourages leaders to look for the “one percenters”: small improvements identified by people who understand the nuances of the work. That requires an environment where employees feel safe, heard and able to contribute their broader skills. Leaders need to invite questions about familiar processes and make room for suggestions.
The responsibility for building that environment starts at the top. Boards and executives need to make expectations clear and provide the systems, education and support that help managers meet them.
Fewster’s advice to provider organisations on how to cultivate leaders who have impact is direct. “Build awareness, be transparent, give them the data, give them the dashboard, run a program to build their confidence and their commercial lens so that they feel equipped to have the conversations.”
