Top 20 NHS Band 9 Chief Operating Officer Interview Questions and Answers
The NHS Band 9 Chief Operating Officer (COO) plays a critical leadership role in ensuring efficient service delivery, financial accountability, and high-quality patient care across complex healthcare organisations. Reporting directly to the Chief Executive, the COO is responsible for day-to-day operational performance, transformation strategies, and organisational resilience. Typically, Band 9 roles command a salary ranging from £109,000 to over £123,000 per annum (2024 rates), reflecting the depth of responsibility and leadership required.
Whether you’re an experienced NHS executive or transitioning from another senior healthcare role, preparing for an NHS Band 9 interview requires clarity, strategic thinking, and a command of real-world healthcare challenges.
Here are 20 high-impact interview questions with model answers to help you prepare and shine:
Can you describe your leadership style and how it aligns with NHS values?
Answer: My leadership style is collaborative and transformational. I prioritise inclusivity, transparency, and continuous improvement—principles that reflect the NHS values of compassion, respect, and accountability. I aim to empower multidisciplinary teams while holding them to clear, measurable standards.
How have you previously delivered operational excellence at scale?
Answer: At my previous Trust, I led a Trust-wide improvement programme that reduced elective backlog by 24% within 12 months while maintaining patient safety KPIs. I used Lean methodology to streamline clinical pathways and fostered cross-functional collaboration between departments.
What experience do you have with integrated care systems (ICS)?
Answer: I’ve worked closely within ICS frameworks, participating in strategic board discussions and coordinating system-wide initiatives such as shared digital infrastructure and patient flow improvements across acute and community services.
How do you ensure financial stewardship in your operational role?
Answer: I use zero-based budgeting principles and monthly financial dashboards to ensure real-time tracking of spend versus forecast. I also engage clinicians in budget planning to align clinical needs with cost-effectiveness.
How would you respond to a sudden service delivery crisis, such as an IT outage?
Answer: I would initiate the Trust’s business continuity plan, communicate transparently with internal and external stakeholders, and convene a gold command group. Post-crisis, I would lead a lessons-learned debrief and update policies accordingly.
How do you approach performance management for senior staff?
Answer: I set SMART objectives linked to the Trust’s operational goals and hold quarterly performance reviews. I encourage a coaching approach while ensuring accountability through clear KPIs.
How have you contributed to achieving CQC “Outstanding” ratings?
Answer: In my last role, I oversaw initiatives such as a new Patient Safety Response Framework and staff wellbeing programmes that directly contributed to the “Outstanding for Well-led” domain.
What’s your approach to equity, diversity, and inclusion (EDI) in healthcare leadership?
Answer: I believe EDI is integral to effective leadership. I’ve introduced reverse mentoring programmes and co-designed inclusive recruitment frameworks with staff networks to remove bias.
Tell us about a time you managed a difficult transformation programme.
Answer: I led a major outpatients redesign, which involved merging digital and face-to-face services. Initially met with staff resistance, I used structured change management and clinical engagement to gain buy-in, ultimately improving DNAs by 30%.
How do you engage with patients and communities to inform operations?
Answer: I’ve led patient forums, developed feedback mechanisms through digital tools, and co-produced care pathway redesigns with service users to ensure services reflect real needs.
What strategies would you use to tackle elective recovery and waiting lists?
Answer: I’d use data-driven modelling to stratify waiting lists, optimise theatre utilisation, and explore partnership models with independent sector providers where necessary.
How do you maintain staff morale during periods of high operational pressure?
Answer: I ensure visible leadership, create safe spaces for feedback, celebrate team wins, and advocate for resources such as wellbeing support and flexible rostering.
How do you balance operational delivery with long-term strategic goals?
Answer: I align short-term performance targets with strategic transformation plans. For example, operational KPIs feed into wider digital transformation or sustainability roadmaps.
What digital transformation projects have you overseen?
Answer: I led the rollout of an EPR system across multiple sites, achieving 98% clinical adoption within three months. I ensured training, change management, and a helpdesk structure were embedded from day one.
How do you handle underperformance in services?
Answer: I take a data-led approach to diagnose root causes, whether systemic or behavioural. I then implement tailored improvement plans, monitor through dashboards, and provide coaching or restructure as needed.
What’s your experience with system-level collaboration outside of the NHS?
Answer: I’ve worked with local authorities and third-sector partners on joint ventures such as integrated discharge hubs, which improved patient flow and reduced DTOCs by 18%.
Describe a time you had to make a high-stakes decision quickly.
Answer: During the winter surge, I made the decision to reconfigure elective capacity into escalation beds. While challenging, this action prevented unsafe A&E overcrowding and maintained patient flow.
How do you ensure clinical safety in operational decisions?
Answer: I embed clinical governance structures into all operational decisions. I involve medical and nursing leads in every phase and ensure decisions are underpinned by NICE guidelines and patient safety data.
How do you manage up—reporting to the CEO and Board?
Answer: I ensure concise, transparent updates through Board assurance reports. I anticipate risks and offer mitigation strategies while aligning my proposals with the Trust’s strategic priorities.
Why do you want this Band 9 COO position, and what unique value do you bring?
Answer: I’m deeply committed to improving NHS services and bringing people-centred transformation. With a track record of turning around underperforming services and delivering strategic goals, I bring credibility, vision, and resilience to this role.
Final Interview Tips for Success
• Be Authentic: Let your passion for patient care and leadership shine through.
• Align with the NHS Leadership Framework: Reference the ‘Healthcare Leadership Model’ and NHS values in your responses.
• Prepare Data-Driven Examples: Use the STAR method to structure responses.
• Rehearse, Don’t Memorise: Know your achievements well enough to speak fluidly, not robotically.
• Ask Insightful Questions: Show that you’re a strategic thinker who’s ready to lead at the system level.
With the right preparation and mindset, you can present yourself as the capable, visionary leader the NHS is seeking for its Band 9 Chief Operating Officer role. You’ve got this!
