‘I am here for patients and that is why I love what I do’
Prof Colette Cowan is chief executive of the University of Limerick hospital group
Prof Colette Cowan: ‘I loved nursing on the frontline, and patients, but my director of nursing at the time put me into an acting role and I loved it from the day I started.’ Photograph: Liam Burke/Press 22
My love of nursing started at a young age. I wanted to make people better and my parents say I was always looking for nurses’ uniforms for Christmas.
I trained as a student nurse at St Vincent’s Elm Park in Dublin, and worked there as a registered nurse in critical care for five years. It was great training with the Sisters of Charity, a highly disciplined area that gave me the professional skills and work ethic I have today.
I trained for three years and then I staffed in surgery before moving into intensive care nursing, which I loved because the sickest people were in my care and I either helped them to recover or helped them to have an easier death.
I then went to Nenagh as a staff nurse, worked my way through the system, and was appointed director of nursing there in 2009. I was the youngest director of nursing in the country at the time, but the funny thing was I had never aspired to be a manager. I loved nursing on the frontline, and patients, but my director of nursing at the time put me into an acting role and I loved it from the day I started.
Chief nursing post
In 2012, when the first new hospital groups were announced in Limerick and Galway by then minister for health James Reilly, I went for the position of acting director of nursing in Galway University Hospital.
I was in that post for eight months before being appointed chief nurse for the seven hospitals in the West North West Hospitals Group, now called Saolta. I stayed in that post for two years, developing the nursing and midwifery element aligned to groups.
That was a tough task because mine was the first such appointment and I laid the foundation for future chief nurses who are now in posts in six hospital groups in the country. It was a challenging role because I had hospitals from Letterkenny to Roscommon to Galway and I had to deal with a workforce of 3,500 nurses. But it was a great job, and I was able to help define the future for nursing and midwifery across the country.
My own daughter, Niamh, went into nurse training and she gave me the whole background on what it was like as an academic discipline.
I linked very closely with NUI Galway at the time in developing different modules at undergraduate and postgraduate level, and that is how I became an adjunct professor in nursing and midwifery.
Ten months ago I was asked by Minister for Health Leo Varadkar and the HSE director general, Tony O’Brien, to take up the role here in UL Hospitals Group as chief executive. I know the system intimately and I love my job because I can make decisions for the betterment of patients.
The varied working week is part of what makes the job so enjoyable. The role of a chief executive is, in one sentence, being the final arbiter or decision-maker in most processes but what is equally important for me is that the team around me are empowered to do their jobs.
I am visionary and have a can-do attitude so developing the strategy of the future is easy.
I get up at about 5.30am and my first job is to check bed capacity and I get that through text message at 6am every day. I know before I start out on my commute what the situation is in the emergency department. I have an hour’s drive to work from my home in Portumna and I spend that time ringing people who are up at 6am. Normally I speak to the night sisters, my chief operations officer and anyone else who will take my call. It’s the same thing in the evening when I leave work. I do all my connecting on the phone when I am travelling.
I have breakfast when I get in to work in the morning, usually about 7am. Normally an espresso is my starting point. I spend the first hour checking emails. We have a lot of work to do with the acute national division of the HSE, the Department of Health, the political system and media inquiries. All of that forms part of every day.
I interact daily with the key people on my executive team. I have a chief clinical director, the consultant anaesthetist Dr John Kennedy. That is very important because if you don’t have medical leadership in the health service, it is very difficult to actually develop a vision for the future.
My chief operations officer, Noreen Spillane, and I talk first thing every morning. She looks at how the group is operating, how we are going to move patients safely, and at any risk or quality issues overnight.
Equally, the chief nurse, Margaret Gleeson, is on at that time and we discuss any nursing and midwifery matters of the day.
The director of HR, Josephine Hynes, and the chief financial officer, Hugh Brady, are other people I need to link in with every day to look at any HR issues or employee relations that may arise on any given day. And because we are using public funds, finance also needs our daily attention and close oversight.
I check in with the system four times a day to see what is happening in the emergency department and on the other sites, to see whether patients have gone in for their surgery and if there are any people waiting.
I link in with the ambulance service to make sure patients are getting transferred out and to see whether we have any discharge delays.
Every Wednesday at 7.30am, I meet my executive team, which includes the clinical directors, for an hour when we go through the issues of the week and plan for the following week. Every month we have a meeting of the executive council, which includes directorate managers who have to give formal reports about what they are developing in their services. I call the executive council the “soul and conscience” of the organisation.
We hold a monthly board meeting, with four executives attending: the chief clinical director, chief financial officer, chief operations officer and myself. We also have monthly performance meetings locally where each directorate has to present to the executive team on progress. I then travel to Dublin for a monthly performance meeting with the acute national division, where I account for the group.
We have a group chief executive forum at which the seven of us meet every month; there we address matters that need to be brought to the national division of the HSE or to the Department of Health.
I am also on a number of committees. I am helping with the DOHC National Maternity Strategy Steering Group, the DOHC Policy on Trauma Network for Ireland Steering Group, the National Emergency Medicine Taskforce and the National Sexual Abuse Steering Group.
I generally aim to leave my office at 8pm. During the day, I am usually on the move around the place rather than at my desk and in the evenings, I try to catch up on emails and calls.
When I get home in the evenings, I spend time with my daughter, Lauren, who is in second level, starting her Leaving Certificate.
When she has gone to bed, I do another few hours’ work and I go to sleep at about 1.30am.
My sleep pattern is narrow, but suits my body clock. What sustains me is that I train three times a week. There is a lot of talk now about “corporate athletes” and how you gain the strength and resilience to do the job you do, which can be relentless at times. So I train three times a week with my personal trainer, Dave Fogarty. I go for a run with him or do other work with him at 10 or 11 at night. That is my mental break away from the phones.
If pressures come on in the middle of the night, say with the emergency department during the winter, I could get a call at 3am or 4am from the night sister for advice. I don’t mind that because they need support and if I can call it for them, I will. You would have to like the job.
I am 27 years in the health service and what grounds me is that I am here for patients and that is why I love what I do. I have no doubt I am in the right job.
I meet patients regularly and if there is an adverse event where families are upset, I like to meet them myself.
Once the reports are done, I sit with the families and talk to them because I am the accountable person.
Staff are important to me too. My style is to work with people. I like to collaborate, I don’t like the authoritarian style. We have a serious amount of talent in the health services.
To that end, we ran the CEO Awards to thank people and staff who are doing great things. Sometimes that is lost with such a focus on the negative.
I am interested in leadership and John Kotter is a guru for me. I am doing my MSc in business and management at the Institute of Public Administration and we do a lot on leadership. It is often a lonely job as chief executive because you are in this fishbowl scenario. People watch what you do and you have to show integrity at all times. It can define the group if the chief executive is not acting with integrity or is not able to lead.
We have lots of good leaders in the health service but we do need to give them the tools to develop and the ability to use the expertise around them to make decisions.
Out of hours
I live in a house with two daughters of 21 and 17, and I absolutely love all the music they play. Our house is a constant boombox of all the latest sounds. I used to listen to rave when I was a student nurse, and I still listen to that, but I also listen to opera in the morning.
My two kids are my absolute rock because they remind me when I walk in that door that I am a mother now. They have all their issues ready for me when I arrive home and it grounds me because I realise they have problems as well. I enjoy them immensely and we laugh a lot together. We do a lot of things together, whether that is going to Ed Sheeran or Kodaline or whoever.
Saturdays are for family. I take Saturdays off and I touch base with my parents, making sure everyone is all right. I couldn’t have had the career I have had without my parents, who helped to rear the kids and are a very important part of their lives. Their good manners are down to my parents.
On Sundays at about 6pm, I start to prepare for the next day.