Occupations and Terms of Reference › Chief operating officer (COO)
Universal terms of reference · POS-004 · version 1.0 · status: draft · next review 2027-10-27
Chief operating officer (COO)
To run the day-to-day operations of all services, so that patients are seen safely and on time, facilities and transport work, and the operational plans deliver the strategy.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You make sure the organisation runs well every day. You turn the strategy into operating plans, manage patient flow, facilities, transport, hotel and security services, and make sure problems are fixed quickly and safely.
Reports to: Chief executive officer.
Leads or supervises: Facilities, patient services, hotel services, transport, medical evacuation, fitness, security and emergency department leads.
What you do on a typical day
- Daily operations review: bed occupancy, theatre and clinic capacity, transport, facilities and incidents.
- Resolve operational problems with service leads, and escalate those that affect safety or budget.
- Review rotas and capacity with the CNO and CMO each week.
- Walk the sites and talk with frontline teams.
- Monthly operations report to the CEO, with action tracking.
- Check contracts and service suppliers for performance and safety.
Working conditions and demands
- Often on call for emergencies and site incidents.
- Work across several sites or facility types.
- High pressure at peak demand; decisions are often needed quickly.
What good looks like
- Patients are seen on time and transferred safely.
- Facilities are safe, clean and working; repairs are completed within target.
- Problems are found by the team and fixed before they reach patients.
- Budgets for operations are held without compromising safety.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every decision that affects patient safety is made on evidence and recorded.
- Patient safety and quality come before financial targets; no trade-off that puts patients at risk is accepted.
- Every staff member can raise a concern without fear of reprisal, and every concern is answered.
- Legal, licensing and accreditation duties are known, owned and reviewed.
- Finances, people and information are managed openly and within the law.
- Mandatory training and policies apply to the executive as much as to frontline staff.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-004 |
| ISCO-08 | 1120 (skill level 4) |
| ESCO | to map |
| Department | Governance |
| Facility types | Hospital, Ambulatory, Transport, Medevac, Fitness, Aesthetic |
3. Reporting line and working relationships
Reports to: POS-003. Supervises: POS-178, POS-144, POS-201, POS-237, POS-246, POS-256, POS-215, POS-135.
| Works with | Nature of the relationship |
|---|---|
| Chief medical officer | Agrees clinical capacity, theatre and bed plans. |
| Chief nursing officer | Agrees staffing and rota plans for wards and clinics. |
| Chief financial officer | Agrees the operating budget and procurement. |
| Chief quality and safety officer | Owns operational safety and incident actions together. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Operations | Makes sure all services run safely, on time and within the operating plan. | Operating plan delivered; patient flow targets met | Monthly | C-01 | T-06 | – | – |
| Facilities and safety | Makes sure facilities, equipment and transport are safe, maintained and compliant. | Maintenance and inspection records complete; compliance audits passed | Quarterly | C-02 | T-05 · T-07 | POL-INC | – |
| Budget and suppliers | Manages operational budgets and supplier performance. | Operating budget held; supplier reviews completed | Quarterly | C-03 | T-06 | – | – |
| Emergency and continuity | Makes sure the organisation can respond to emergencies and major incidents. | Business continuity plan tested annually; exercise records | Annually | C-02 | T-07 | POL-INC | – |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Daily operational priorities and staffing deployment within agreed budgets | Changes that affect the operating plan or the budget beyond delegated limits |
| Operational contracts within delegated limits | Operational failures that affect patient safety |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Degree in management, engineering, health services management or a related field | Yes | Lifetime |
| Q-02 | Operations or health management postgraduate qualification | No | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Senior operational management in a health or complex service organisation | 8 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-02 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | C-01 · C-03 |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | C-02 |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-04 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Operational planning and capacity management | Follows operating plans | Plans capacity for a service | Designs integrated capacity across the organisation | Operational performance review | Every 12 months | T-06 |
| C-02 | Operational safety and risk management | Reports operational risks | Leads risk actions in a service | Designs operational risk controls across sites | Risk audit | Every 12 months | T-05 · T-07 |
| C-03 | Budget and contract management | Monitors a budget | Manages a budget and supplier contracts | Sets operational budgets and value for money | Budget review | Every 12 months | T-06 |
| C-04 | Leading managers and teams through change | Works within a team | Leads a team through change | Leads organisational change safely | 360 feedback | Every 24 months | T-08 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Patients transferred or discharged within agreed time | set by facility | patient flow data | Monthly |
| PI-02 | Maintenance requests closed within target | set by facility | facilities system | Monthly |
| PI-03 | Operating budget variance | within agreed tolerance | finance reports | Monthly |
| PI-04 | Business continuity exercises completed | 100% | exercise register | Annually |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Chief operating officer (COO) | 8 years (recommended) | Q-01 | C-01 expert, C-02 practitioner | T-07 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |