Abstract
Variation persists in the quality of board-level leadership of hospitals. The consequences of poor leadership can be catastrophic for patients. The year 2019 marks 50 years of public inquiries into healthcare failures in the UK. The aim of this article is to enhance our understanding of context-specific effectiveness of healthcare board practices, drawing on an empirical study of changes in hospital board leadership in England. The study suggests leadership behaviours that lay the conditions for better organisation performance. We locate our findings within the wider theoretical debates about corporate governance, responding to calls for theoretical pluralism and insights into the effects of discretionary effort on the part of board members. We conclude by proposing a framework for the ‘restless’ board from a multi-theoretic standpoint, and suggest a repertoire specifically for healthcare boards. This comprises a suite of board roles as conscience of the organisation, sensor, shock absorber, diplomat and coach, with accompanying dyadic behaviours to match particular organisation aims and priorities. The repertoire indicates the importance of a cluster of leadership practices to fulfil the purposes of healthcare boards in differing, complex and challenging contexts.
Highlights
The public sector board has social performance and the creation of public value as its two central purposes.[1]
We concentrate on two research questions within that study: first, what does theory and empirical evidence from this study tell us about an appropriate range of roles for healthcare boards? Second, what are the associated behaviours connected with these roles? To address these questions, we examine the relevant literature on the role of boards within healthcare organisations, drawing on combined and complementary theoretical perspectives of board composition, roles and dynamics, with a particular focus on the interplay of these with the quality and safety of care provided by hospitals
This paper aims to further our understanding about an appropriate range of roles for boards in the context of healthcare, and associated behaviours connected with these roles
Summary
The public sector board has social performance and the creation of public value as its two central purposes.[1]. The intended effect is more authoritative boards, as well as more empowered management.[2] The events at Stafford hospital in England are arguably an unintended effect of this position: the board there was deemed to be distant from, and largely unaware of, the daily realities in the hospital, with attention primarily on financial strategy.[3,4]. The normative position, in many jurisdictions, including in the NHS in England, since the advent of New Public Management (NPM) principles, is that public sector boards largely follow the example set by the commercial sector.[5] There has been some concern expressed that there can be transferability problems and issues of institutional isomorphism,[6] in this case when governance structures and processes are copied without regard to their relevance to the public sector context
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