We hope you enjoy this feature from our July – August 2013 edition.
Trish Noakes – Founder and CEO, Just Better Care Australia
By Keryn Curtis
“The private sector will always spot the opportunity but there are a lot of potential cowboys that want to come in who don’t understand the business and they’re not interested.”
Trish Noakes has been busy around the aged and community services traps in New South Wales for longer than she probably cares to remember but in early 2012 her name, and in particular her business, shot to the attention of a much wider audience.
In late February last year, Australia’s leading business magazine, BRW, named the business Noakes founded, Just Better Care, as the country’s 10th fastest growing franchise and the fastest growing franchise in the home and community health care sector.
Just Better Care currently has 30 franchises around the country. The majority are in Sydney and on the central coast of NSW, where Noakes has always lived, but there are seven operations in Melbourne now, two in Perth and others in Brisbane, the Gold Coast, Canberra, the Illawarra and regional Victoria.
A further 52 locations across Australia have been earmarked, based on their demographics.
In a sector dominated by mission-based not-for-profit organisations, it might be tempting for some to see the Just Better Care franchise as a shallow entrepreneurial enterprise, designed to capitalise on the potential financial boon presented by the advancing baby boomer cohort. This would be not just unfair, but incorrect.
Noakes gives short shrift to anyone who darkens her door, wanting to talk about growth sectors and returns on investment.
“The private sector will always spot the opportunity but there are a lot of potential cowboys that want to come in, who don’t understand the business and they’re not interested,” says Noakes.
She estimates she receives 200 to 300 franchise enquiries a year from people in that category.
“And US companies think they can simply roll out an American model,” she adds.
But Noakes says being interested in people and communities and wanting to ‘make a difference’ is the key prerequisite for taking on a Just Better Care franchise.
“Like any business it is about the brand so you need to be sure the franchise owner is coming in for the right reason. Most of our franchisees are in their 50s and they might have worked in some area of the health or care sector or they have had a family member with a disability or an ageing parent perhaps.
“They are looking for a business that can make a difference; that they can work with and stay with over the long-term and feel they are doing something of real value. That motivation creates passion and drive and that’s important to have because these are complicated businesses to run. You’re not producing coffee and a muffin,” she says.
Noakes believes human services make for the most complicated franchise system around.
“You are dealing with individuals and each one is different. The way one 85-year-old might look for some support is very different to the next. People may feel very socially isolated; they can have complex disabilities and co-morbidities. It can present big challenges to staff. That’s why we need owners who have the ability to be strong leaders.”
The right fit
Unsurprisingly, Noakes’ background reflects dual interests in nursing and care, as well as business.
Growing up in Newcastle before moving to Sydney at age 17, Noakes says she was strongly influenced by her father.
“My father was a state manager with Woolworths and he would sit down and talk about business a lot and he had a sort of ‘Harris Farm’* idea that he thought was a real opportunity that hadn’t been picked up.
“Unfortunately he died young, but it stirred up my sense of wanting to be in business,” says Noakes.
“I did nursing and then psych nursing. But I got frustrated with the system; with going to meetings and putting forward ideas and then seeing nothing happen. No change. That was the driver for me to start my own business,” she says.
That business – Noakes Nursing Service – began in 1995 as an agency providing staff to private hospitals, aged care facilities and other residential care settings. Noakes says it evolved more or less organically into community care nursing because people often wanted to retain a level of nursing care when they went back home.
The business was purchased by Wesley Mission in 2002, becoming Wesley Noakes Nursing Service, but was subsequently sold again to another private community nursing agency, KinCare in 2008. In the meantime, Noakes established a new business for herself, Just Better Care, in early 2005.
Keeping it local
For Trish Noakes, the franchise business model was the one that made the most sense for community-based care.
“You need size,” says Noakes, “to be able to put efficient systems in place. You need volume, or you don’t survive.
“But the problem with volume is that you can get too distant from your customer and what they really want. So how can you get volume without being distanced from your customer?” she asks.
“That’s when I got interested in the franchise model, which seemed to be the best option around.”
Noakes firmly believes that a centralised model can’t deliver a real understanding of the subtleties of local customers and be truly relevant to the local market, especially in a consumer directed care (CDC) environment. By contrast, she believes the franchise model can deliver the volume while retaining the local presence.
“You can centralise the systems with IT, branding, marketing etc; but the face-to-face service delivery across Sutherland, Bankstown, the eastern suburbs, Hawkesbury, Chatswood… it will all be really different.
“And you actually need to be in those local areas to understand them. How else do you get to know how that community works, unless you become a part of it?” she asks.
“People will be looking to their local communities for connections and engagement and involvement and you need to know what is around and who is around. Which hairdressers will do home visits? What volunteer group can take you to the club, etcetera? Which pharmacies and supermarkets will do home deliveries? You can’t pick it all up from websites.”
The right model
In the CDC environment, it just makes sense, says Noakes.
“At the moment, all the service provider organisations have the power and control.
“But with a more customer-focused, market orientated system, the power and control will shift from the organisation to the person receiving the care themselves, and their family.”
“I think our model is very suitable for the future of community care provision, where people will shop around and say, ‘I have this entitlement of care’ and they will want the provider to show how they can best meet their needs with good, quality services that are flexible and individual.”
Noakes says there has been a prevailing view that community care and other human services operate on different fundamental principles to other businesses and sectors but she disagrees.
“Customers want to have their needs met. That is no different in community care,” Noakes says.
“And like all franchise operations, the owner wants to succeed and they make sure they do a good job meeting customer needs.”
A people business
Central to this faith in the model, franchisees retain a great deal of flexibility in the way they structure and deliver their services. Noakes says theirs is a model that empowers franchise owners and also staff, rather than being prescriptive.
The franchisee needs to set the culture of the organisation but the staff, she says, is ‘the eyes and ears’ of the business.
Part of the culture of Just Better Care is to ‘offer’ work to staff, rather than simply roster people on. “It’s about what you can bring to the service and some people will be good at personal care work while others might prefer working with someone who needs more emotional or social support,” Noakes says.
While Noakes is the first to acknowledge that things aren’t perfect (“we need to invert the organisation and bring the knowledge from staff back into the organisation so we can learn from them”), their staff turnover rate is 11 per cent, considerably better than the 25 per cent average across the industry.
“Your staff are integral because they are the ones out there in the community every day but they might not know about ‘services’ and ‘models’. So we need to engage them and ensure they understand and that they can communicate that message to families and to the older people themselves, using the right kind of language.
“The language has to change too, from a language of loss and passivity. We need to work with people around their wellness and working toward what they CAN do. And when they achieve it, what they can do next.”
A natural collaborator with a palpable passion for innovation and a can-do approach, Trish Noakes seems to have hit her perfect stride with Just Better Care.
Her enthusiasm about community networking is infectious and she has a very hands on approach to bringing about change, which seems to come, at least in part, from a personal investment in wanting a better society to grow old in.
“We have a mindset about old age that you need someone to manage your affairs and look after you. I want to be the decision-maker in my own life. Me, in my fifties, I am thinking about what I need to do to have a good outcome in the future. And so many things need to change in the next 10-20 years.”
* Harris Farm is a successful family owned ‘farmer to market’ produce business in NSW.
Trish Noakes on aged care reform
At the moment there is a lot of moaning and negativity but the clock won’t go back. We will move to a deregulated marketplace without a doubt. In five years, when we have a bit of a flavour for CDC, people will be demanding it. The system has been so blocked and inflexible and hasn’t worked for so many people. Why would we go back?
Noakes on CDC
One thing I learnt [in psychiatric nursing] at the time of the Richmond Report, was that people coming out of [psychiatric institution] Gladesville and living at home for the first time, when you took them shopping, all they’d want for the first couple of weeks was chips and Coke. But they soon got sick of that and then got interested in planning and shopping for meals.
It’s no different for an older person. The CDC pilots found that once people became more confident with the system they started using it differently and trying new things. The choices they make are important to people. We need to empower them and assist them to step up rather than down or backwards.