Interview With Tony Stein - CEO of Care Home Operator Healthcare Management Solutions

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Tony Stein has managed hundreds of care homes. In this fascinating interview he shares his underpinning values, formula for success and commitment to high quality care.

Liam Palmer:

Hello everyone, it's Liam from the Care Quality Podcast, Meet the Leaders and Innovators. We've another treat for you today, meeting with Tony Stein, who is the CEO and owner of Healthcare Management Solutions Limited, who run a large portfolio of care homes with an interesting business model and quite a unique ethos. Tony is, in my view, a teacher leader, humble and self-aware. There's a lot packed into this episode, and he's generous to share some of the underpinning principles and values that enabled him and his group to be as successful as he has been. Without any further ado, here you go, Tony Stein. Tony, a very warm welcome to you.

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Tony Stein:

Hi Liam, good to talk.

Liam Palmer:

Yeah, excellent. I've been looking forward to having you on the podcast for a little while. Would you like to tell the listeners what you do today, and give us a little bit of background about you as a leader in social care, or what you do in your job, effectively

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Tony Stein:

Yeah. I have, I think, probably one of the more interesting jobs in the sector, and I love every single day of my work. Basically, Healthcare Management Solutions is a business that we set up, my business partner and I, Kevin Groombridge, we set it up about 12 years or so ago, and we did it in response to a need in the marketplace for a professional management solution for care services. At the time, it was because there was a huge demand for somebody to operate care homes on behalf of investors and banks, where businesses were in distress. This was the crash of 2008 I'm talking about now.

A lot of businesses were struggling, and of course insolvency practitioners, whilst being good at what they do, weren't very good at running care homes. The business took off like crazy, and in order to deliver the service that our clients needed, which was to run care homes but with a view, then, to onward sale, we had to develop systems that would allow information to be very easily shared with our clients. But, would also fit the management of businesses that'd come from a variety of different sources and were in a variety of different states.

Over the years, we're delivering a broad range of services but within quite a narrow field. We deliver consultancy, management, turnaround and due diligence services within the elderly, mainly elderly, we do do some specialist work, but mainly elderly residential care sector. And, the consequence of that is that the business brings with it such a variety of experience, so every day is different. Every day, I'm dealing with turnaround jobs, I'm dealing with providing services to people who are looking to invest, so we even get involved in the design of new care homes. We are involved in management. And often, we're helping clients who've got difficult situations to deal with. Yeah. Fascinating, fascinating position to be in, with such a variety of work to challenge us.

Liam Palmer:

Yeah, absolutely. Very, very interesting. I'd heard a bit about your company, as we'd discussed before, a role had come up, I think it was a regional director role in the West Midlands, but the timing wasn't quite right. That was when I researched a bit about your business, and I saw it was head office I think in the West Midlands, and talked to a recruiter. They were saying about how this was a very forward thinking organization for social care. The timing wasn't quite right, but very interested in your business model. Your organization picks up homes, manages them, and then what? Gives them back? What do you have, a support team of home managers, or how does it actually work?

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Tony Stein:

It's a bit strange, really. If you look at our organization, you would see there's four or five different parts of it. There's one bit which would, for most operators, would be very familiar. We are an operator of care services, so we have HR, IT, estates, finance, operations, quality, all in our head office structure.

We operate half and half, really. Some of it is longterm management for our clients who are looking to build portfolios, who want to invest in the sector but don't actually want the day-to-day operational responsibility.

So we could take those, and we'll be running those for however long for that client. They may choose, at some point, to exit and if they do, we may end up continuing to operate for the new owners. But, we also operate for investors who've got specific issues and they want somebody to manage the services, provide them with four or five years of good performance, good quality information, and then look to sell to a third party.

In addition to that, the head office has a team of people who are working pretty much all the time on software development.

When we started this, we did it because ... Well, for two reasons. One is because we needed a way of monitoring quality, that allowed us to check progress with that in the long haul. Everybody we spoke to, or I spoke to 20 years ago in this sector, had audits that they carried out in their services. They were mixed, I would describe it as mixed, in terms of the quality. Some of them covered everything in great detail. Some of them covered certain areas of the business in very much detail, and then left others completely ignored.

What we wanted was something that would cover the entirety of the business, but would be set in such a way that you could repeat that on a regular basis. And then, you could check the progress of the business, in terms of how it was improving or deteriorating. And you could select certain areas to re-audit, as well. We developed our impact audit system, and that then led us to developing a much, much wider ranging management information system, to allow regional management, home management and senior team to understand the business.

We've been developing this software for years now. I know I would say this, but having seen a lot of the software in the sector, I'd certainly say it's best-in-class. Most people that I show it to are generally very impressed. We're looking, this year, to expand that as an offering to third parties, rather than just something that we use internal. We will be branching out to become a software business.

In addition, we have a team of troubleshooters that we use around the country, to assist people with their more difficult challenges, should I say.

Liam Palmer:

Yeah, fascinating. Certainly, the two themes I'm focusing one as part of my development around social care is the contribution of tech, of good tech, of relevant tech. And then, the contribution of effective leadership and culture, and it's the interplay of those two. Obviously, we've talked a couple of times before, and that's exactly what you've done at the same time. But obviously, you've had to pickup sites, and groups, and you've literally needed that straight away, haven't you? You've needed a tool to be able to discharge your responsibilities to your customers, so very, very interesting that you have developed it.

Tony Stein:

I would certainly agree with you, that having a team of people who have the right culture, the right approach and the right experience and knowledge, doing the right things is probably the hardest part of this business. A lot of the people that work with me now are the people who worked with me 20 years, ago, and I get a great pleasure in having that longevity of relationship with people. It's not always easy.

I have a very, very good MD who keeps me honest. And, I think the thing that I've learned from her, more than anything, is that businesses succeed by being consistent with people. I would like to think that the team of people that work with us know who we are culturally, they know what we stand for, they know where our moral compass lies, our ethics, our belief in how we deal with people and the business. We're always honest, we're always fair. I think if you can keep that consistency going at all times, it doesn't matter how hard the going gets, then people will respond to that well and they trust you. I think it builds a trust over a long period of time.

I think that's where most people get it wrong, if I'm honest. I think they're inconsistent. I think they're fine for a while, and then things go a little by awry, and then they maybe give the wrong messages to people and people get nervous, and uncertain. But, we're very, very consistent, that's what we try for.

Liam Palmer:

Yeah. Well, it certainly sounds like it's a differentiator for you, isn't it? Certainly, I've worked in a few organizations across social care, there are some great companies out there. And similarly, yeah there are some cultures where senior management are not consistent to values, or ethics, and lovely until something goes wrong. And then, it all [crosstalk 00:12:10]. It's such a shame.

Tony Stein:

It's not always when things are going wrong, either. I think when people, for example ... Let's take one example.

You've been running a business with a loyal staff for five, 10 years and then you decide you want to exit. It's often at that time that you start to look around and see if anybody might be interested in your business and so on, and people might express some interest and they might want to have a look at the business. And then, the staff start to find out that the business might be being sold. They've not been told that, but it just comes to their attention, and then the trust disappears. I think, often, people are worried about being honest with their staff and the response that might get. I've always found that that may well generate some short term uncertainty and nervousness.

We, as an organization, our portfolio of homes fluctuates. Someday, we've been running up to 125 services, as of today we're running 70 services. Now, some of the staff, rightly, might get worried about that. They might feel, "Well actually, where's our longterm future? Does that mean that the business is going to shrink? Are we going to lose people?" We've always been exceptionally honest with our team about where we are in terms of the pipeline of work coming in, and where we feel that that's going to go, and what pressures that might put on us and so on. I think, if you can continue with that honesty, then that does a lot to allay the anxieties. People don't tend to jump ship, but they trust us. I think that's the thing.

Liam Palmer:

Yeah. Yeah. It sounds so simple but it's radical, isn't it? The fact that so few people do it ... I was interested in, it was a book written by that Tesco CEO that was really, really successful for a long time, and every single quarter he had growth over 13 or 14 years. I read his book. How on Earth can you do it? It was what you're talking about. He was honest. He'd go round and solve problems, have a real conversation.

Tony Stein:

Yeah. Look, he was trustworthy. Trust goes both ways. You've got to trust your staff as well. Not just them trust you, you have to trust them. You have to trust that they will respond properly and in the right way, and they'll do the right thing at the right time. I think if the trust isn't there between you and the people that you work with, then there's so much for it to go wrong. And ultimately, there's no loyalty either.

It's the fundamental principle behind running a good business. The one thing, people will hear me say this often when we have a new starter. I always say to people that just started with us, "I hope you enjoy working here, you'll be well supported and well looked after. But if you ever got to bed on a Sunday night, dreading going to work on Monday morning, then you need to come and talk to us. Because I've actually been there, in my career, and it's the worst feeling in the world."

Generally speaking, I think if you can be open with the people you work with about that, and why it's happening, that can be fixed. But, you don't work for love, you work out of necessity generally. But, that doesn't mean it can't be enjoyable and it doesn't mean that you should work with people that you like, trust, and have the same cultural approach to what you're doing.

Liam Palmer:

You've obviously done that well, to keep the engagement of your staff over the long haul. Especially with lots of change projects, which inherently are a bit risky in some ways, in terms of employment perspective. That approach is obviously working really well for you, so it's really good.

Tony Stein:

We do have a mixed bag of people that work for us, it's very interesting. We've got some members of staff, particularly on the operational side, who love the challenge of turnaround. And actually, when a home's fixed they just want to move on because they've done their bit. We've got others who actually would prefer the ongoing day-to-day management, and keeping things on a level keel. And actually, both are as difficult but they're both different jobs. It's finding the right tool for the right job. We've got a real variety in amongst the team. It's actually lovely seeing people develop and finding their niche.

Liam Palmer:

Yes. Yeah. I certainly got that from speaking to you before, that I think you used the word, something like talent spotter or something. Identifying talent and drawing new people into the business and stuff like that, you've got that eye for who can make a contribution and stuff. As a proper leader, getting the right people into your company is half the battle isn't it, I think?

Tony Stein:

It's very difficult. I'll tell you, it's exceptionally difficult in small and growing businesses. The reason for that is you've got a very small team, generally, that are trying to do a myriad of things, particularly when you're growing.

I have a very visual mind, and the way I see it is you've got a selection of shapes and you've got a selection of holes appearing. What people tend to do is find the one that nearest approximates, and gets a big hammer and forces it into the hole. I think you can do that for a while and people are happy to accommodate that, but eventually they get sick of being forced into that hole that doesn't fit.

I remember when we first started our business, and there were five of us. We were getting homes thrown at us left, right and center. "Can you manage these five?" And, "Can you manage this six?" And, "There's 10 here that have got a problem. And then, we've got this one that's falling over." When you're running a business, you're not just going in there and managing that service, you're renting office space, and putting computers in, and renting cars, and buying phones, and doing all the stuff that running a business needs. But, there's only five of you so you pick up jobs that you're not always great at. That's the problem when you're growing a small group of care homes.

As a business owner, you've got four care homes. I think the smaller number, the three to say a dozen care homes, that's a really difficult size of business to run because, with all the demands placed on you in the modern care sector of regulators, commissioners, fire officers, environmental health officers, insurers, all these people have got demands from you that you've got to meet, and you've only got a small team, generally, to do that. I actually think that's a very difficult size of business to run. I think it gets much easier when you get beyond 20 because you've got a back office, and you've got somebody you can hire and afford to just look at quality, or just look at IT, or just look at HR. But beneath that, you've got to find people who will cover those basis, and they're not always very good at that. Or, have the time to do it.

My heart goes out, and especially over the last 12, 18 months with the pandemic, because I think not only are they trying to juggle all of those balls, and deal with all of the things they were trying to deal with before, but they've had this additional problem to deal with as well. It's been a really rough 18 months. Or, 12. It feels like 18 months, it's not. It's about, what, 14 months now?

Liam Palmer:

Yeah. It's not easy working in care homes right now, I can definitely attest to that.

Tony Stein:

Well, it's the old story isn't it? As people will say, "It's not rocket science." Actually, it's harder. I think actually probably firing rockets up in space is probably easier, because there's a lot of physics involved and a lot of calculations. But, what we're dealing with is people and they're less predictable. Yeah, it's a lot harder than rocket science.

Liam Palmer:

No, I would agree with you. I would agree with you. Obviously, you developed this competence, or set of competencies within your company, to be able to offer what you're offering and do it to scale, with the 70 homes you've got now, and beyond at times. Would you like to just explain for the listeners, how did you get into this work? And, how did you have the experiences that gave you the underpinning knowledge or perspective to know how to do this? Yeah, it's an interesting little niche you've got here, isn't it

Tony Stein:

Yeah, I came into this, as a lot of people I'm finding came into the care sector, not deliberately but just got into it by accident, and found a home here.

I was an accountant, I worked in one of the Big Six, I worked for KPMG. I also worked at Grant Thornton, in their insolvency recovery department. I wanted a job in the industry as a finance director, just to broaden my experience of running finance in industry. The first job I got, I was working for Carlsberg Tetley Brewing, actually. But I was actually, again, it wasn't the standard finance director role, I was looking after their loan book. I then moved out into industry and I got a job with a care home business. It went from there, basically.

Within a year, I was asked to join NHP. NHP was the largest owner of care homes in the country at the time, they had over 200 care services. For a variety of different reasons ... they were a prop co, so basically they're tenants all over the country. The leases weren't well structured, and a lot of those tenants ended up folding. The only route to taking those out of administration, or receivership as it was at the time, was actually to become an operator and take them out ourselves. So over a period of five years, we grew a business, an operating care home business, from six homes to 200 homes. It was a baptism by fire, and at the end of it I was pretty much a wreck. But thoroughly enjoyable, and learned a lot and met a lot of very, very good people. I think it took me that five years to realize exactly how hard this is. It's a very tough job.

But, I realized that there are people who are very good at it, and that's how I ended up here. But, I wouldn't do anything else now, if I'm honest. It's not just the fact that, hopefully, I've got a lot of experience in this particular field. I know it sounds a bit trite, but actually when you go into a care home that's got problems, and it's not well run, and the residents are not having a great experience of their final years and you can turn that around, and you can give the staff somewhere that they want to work, you've got residents who are getting good quality care, that's brilliant. That's a major tick, for me. I think that's where all of our staff get the buzz.

Liam Palmer:

Yeah, 100%. I think perhaps we could talk about your approach to quality, and I know that's tied into your thinking about the use of IT. I think it'd be really good to hear your perspectives on both, especially where a lot of social care doesn't have a deep sense of ... A lot of IT tools that they're actually using is still quite a large dependence on paperwork systems, or systems are not integrated in some ways, and you've taken a different approach. But, do you want to maybe talk to us about your approach to quality? And then, perhaps how the systems fits into that?

Tony Stein:

Yeah, certainly. I'll get to the systems in a minute, but systems is a separate issue. Quality in itself is about consistency and it's about culture. You've got to embed practice to get great quality, because quality means different things to different people.

For me, I'm very focused on outcomes, and outcomes for residents. But actually, if I just focused entirely on that then I wouldn't satisfy the requirements of, for example, the CQC, the CI, CSSI, WRQIL, whoever the regulator is.

They want to see that the paperwork that sits behind is evidence in that quality. Now, there's a difference. There's a difference between are you delivering a good quality of care and are you able to evidence that you're delivering a good quality of care.

What you'll often find, when you look at care homes, is that the residents, and you'll see this a lot in CQC reports, the residents will say when asked do you enjoy living here, do you feel safe, do you feel well looked after, they're full of praise. "Yes, I love it here. I'm well looked after, the staff are wonderful, they're angels. I feel safe, I feel supported." And yet, you can still end up with an inadequate or an RI, and that's because the provider isn't able to evidence how they're dealing with that and how they're delivering that. Those are two different things.

Your care home manager has to be both a good leader, and to embed good cultural approaches to delivering quality of care for the residents, but they need to be a world-class administrator. They need to be on top of the recording of what they're doing, and how they're recording it, and making sure it's done properly. That, to me, the quality systems are about checking and making sure that people understand it's not just about the delivery of care, it's about how they record and evidence that, and being consistent about that. Our systems, we developed our systems so that you can measure the progress very easily, across a large number of services if necessary. You can determine where in the myriad of things that you have to deal with, where you're better at that, and that can flow through to your home development plan.

The systems allow you to track and trend, and all the rest of it, so that's important. But actually, the systems themselves are not the thing, it's the process. You have to have this constant circular thing, where you're reviewing, you're auditing, you're testing, and then you're getting the outcome of that and you're putting that into actions. And then, that in itself you see, then, flows back into better quality so it becomes a big circle. Yeah, that's it. Again, it's consistency.

Liam Palmer:

Okay. That's the best explanation I've ever heard about how to get it right, that balance between actually providing the care versus the evidencing compliance part being equal important. But obviously, when you talk to compliance people all they talk about is how compliant you are, in some ways not how you're running the service, which is interesting.

Take us from there, then Tony, to how and why you've developed this tech solution and what's unique about it. I've seen it, it's very clever. It's got lots of layers of thinking in it. But for listeners who this is a brand new idea, maybe take us through the connection from quality to system, if you can?

Tony Stein:

Yeah, okay. When I show our systems to people, there's a sort of a penny drop moment. Where I think most people will land is, actually, this is obvious isn't it? But actually, nobody else is doing it. Well, I say nobody's doing it, people are doing it, but to different degrees and with different degrees of success in my view. What we try and do is we try and get the computer to do all the simple stuff that computers can do, so that our people can do what only people can do.

The good example would be you've got a team who are monitoring quality across care homes. What you don't want is you don't want to be paying people whatever you're paying them, 50 grand, 60 grand, 80 grand, 100 grand a year, whatever it is, to simply sift through information to find out where the services are weak and where they need to focus their attention. Computers can do that, provided the input's good. Our systems help to do that sifting, that trending, that identifying the weak areas, so that the team's don't spend any time doing that, they don't need to. They can just literally focus in on, right this is where we need to be concerned, so we can now start to put together an action plan, which will be different for every care service, about how we're going to tackle this particular problem, and how we're going to deliver the right results at the end of this, and measure that those right results look like.

If you go into our systems, you can hunt around with a mouse in a matter of moments, and look at dashboards which will explain whether you've got financial problems, whether you've got marketing issues, whether you've got care compliance problems. How you're faring with infections, and pressure ulcers and so on, and you can trend that, and you can see where that looks compared with other homes in the group, and et cetera, et cetera. The system's doing all of that good stuff for you, it's done. You've got to record this anyway, so you might as well record it in a system that's going to track and trend it for you. And then, going to point out where you need to look. That's what our systems do.

Now again, it's not technically very clever, but it's just not something that people have done very well. I like to think that our team of people, who as I say, we rely on for their peculiar skills, I don't want people to spend their days shifting through Excel spreadsheets, for example. I don't want to pay somebody to have to take Excel spreadsheets from 20 different services, and pull them all together and try and understand them. I want the system to do all of that in the background, so that the team are doing something really more interesting. That's really our system.

Now, as we move forward, we're integrating more and more stuff into that system. So tracking care on tablets, which there are lots of systems out there for recording care on tablets. That's, again, not new. But, our systems just go that bit further with that information to help the staff in the homes do something with it, make it work for them.

Liam Palmer:

So there you go, the interview with Tony Stein. I wonder what stood out for you? For me, it was Tony's focus on honesty, on consistency with staff, on being trustworthy over the longer term in his dealings and leadership of his teams. It was also putting a high value on retaining trusted staff through sound management action, through sound communications. And lastly, it's a personal view, naturally, but I think if you can make something really simple, if you can break it down to its constituent parts, I think that is the measure of real subject mastery.

I've heard elsewhere the saying that "if you can explain it clearly, you don't get it," and I think Tony very clearly articulated his deep understanding of the interdependencies around operating care services. I know I certainly learned a lot from listening to him, and equally I hope you enjoyed it as well. Thanks very much.