Interaction between non-executive and executive directors in English National Health Service trust boards: an observational study.

Rod Sheaff,Ruth Endacott,Ray Jones,Val Woodward

doi:10.1186/s12913-015-1127-2

Rod Sheaff, Ruth Endacott + Show 2 more

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https://doi.org/10.1186/s12913-015-1127-2

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Abstract

BackgroundNational Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a ‘public firm’ model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. In this paper we compare the non-executive directors’ roles and interests in, and contributions to, NHS trust boards’ governance activities with those of executive directors; and examine non-executive directors’ approach to their role in board meetings.MethodsNon-participant observations of three successive trust board meetings in eight NHS trusts (primary care trusts, foundation trusts and self-governing (non-foundation) trusts) in England in 2008–9. The observational data were analysed inductively to yield categories of behaviour reflecting the perlocutionary types of intervention which non-executive directors made in trust meetings.ResultsThe observational data revealed six main perlocutionary types of questioning tactic used by non-executive directors to executive directors: supportive; lesson-seeking; diagnostic; options assessment; strategy seeking; and requesting further work. Non-executive board members’ behaviours in holding the executive team to account at board meetings were variable. Non-executive directors were likely to contribute to finance-related discussions which suggests that they did see financial challenge as a key component of their role.ConclusionsThe pattern of behaviours was more indicative of an active, strategic approach to governance than of passive monitoring or ‘rubber-stamping’. Nevertheless, additional means of maintaining public accountability of NHS trusts may also be required.

Highlights

National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a ‘public firm’ model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management
The observational analysis suggested that Non executive director (NED) used six main types of questioning tactic
Supportive comments acknowledged - in one case to the extent of being congratulatory, and in others by means of leading questions – that the organisation was functioning as the board desired (e.g., I am impressed with this report and the extent of working with partners.), endorsing them, encouraging them to continue and re-asserting that board decisions, or the actions taken to implement them, had been sound

Summary

Introduction

National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a ‘public firm’ model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. Sheaff et al BMC Health Services Research (2015) 15:470 directors’ normative beliefs and interests with those of the non-executive directors who represent the nonmanagerial stakeholders in the board In corporate boards the latter are predominantly financial interests (shareholders, investors); in public organisations’ boards, the state’s interests; and in third sector organisations’ boards either the general public or more ‘diverse’, specific stakeholders’ interests [6, 7]. It is anyway irrelevant to non-corporate settings, where other means are required for aligning managers’ interests with those of the ‘stakeholders’ whom the board represents These means include: step in board decision-making processes was often missing, and that the role of NEDs should be more than a ‘rubber-stamping’ exercise, with the appointment of NEDs who are prepared to focus on high level risk issues [16]. The behaviours through which board members make managers and workers accountable appear to fall within three main approaches: 1. A transactional approach: the board and managers negotiate a modus vivendi which appeals to the intrinsic, the financial, motivations of either party [5]

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