Effective behaviour in the boardroom

The findings of the public inquiry into the failings at the Mid Staffordshire NHS Foundation Trust will undoubtedly have a serious impact across the health care sector. The Francis Inquiry has a specific remit; what was the role of the commissioning, supervisory and regulatory bodies in monitoring the trust? However, the Inquiry report – due in early 2013 – is certain to raise the profile of wider issues that contributed to the failings, including the role of the Trust's board.

The Inquiry report is expected to focus on a number of issues that are related to the functions of a board: patient feedback; safety and quality of care and the collection and use of data that supports this; and the role of foundation trust governors and members, and other local public, patient and staff representatives.

With the final report looming, what sorts of behaviour should we be seeing in the boardroom?

Lessons from the Francis Inquiry

'The Mid Staffordshire Inquiry and the earlier report by Sir Robert Francis have thrown into sharp relief the need for boards to be honest with themselves,' explains Katy Steward, Assistant Director in Leadership Development at The King's Fund. 'At that trust, the reluctance of the board to engage meaningfully with governors, patients and staff over their concerns is well documented.'

Below we consider some of the other behaviours necessary for successful board leadership.

Respect and challenge

'Mutual respect is key,' says Mary Elford, Non-executive Director at East London NHS Foundation Trust. 'Not only between the chair and chief executive, but between the executive and non-executive members and across the executive team.'

'Respectful listening is important as well,' adds Angela Greatley, Chair of Tavistock and Portman NHS Foundation Trust. 'Board members need to be prepared to challenge too, not in an aggressive mode but in an effective way that brings about open and honest discussion.'

Ruth Carnall, Chief Executive of NHS London, agrees that challenge is important: 'I think there can be any amount of discussion about how to do something and it's perfectly okay to have challenge between the chair and the chief executive. However, there shouldn't be any dissonance between these two roles about the direction of travel.'

Good governance

Other important aspects of behaviour relate to the governance of meetings. Angela explains: 'The board papers should demonstrate the thinking that has gone into preparing them, to help the executive get what they need from a meeting, being mindful of what board members have raised before and looking at both external and internal environments.' Mary agrees: 'Board members need to understand why a paper has come to them; it shouldn't be a recycled executive paper but redrafted so it pulls out the key points that the board needs to focus on.'

Understanding culture

'Effective board members should feel under pressure to understand the culture of their organisations,' says Katy. 'They need to understand the "soft" or organisational factors, such as staff morale, which sit alongside hard data and consider how both combine to affect performance.'

Although the role of the board is to focus on the strategic issues that the organisation is facing, Angela supports the view that boards need to understand the detail and what this means: 'Sometimes boards need to ask questions about more operational aspects; we should ask "do we understand enough of the operational details for us to take a strategic lead?" We need to connect the soft and the hard information we get to do that effectively.'

Developing boards

At The King’s Fund we have worked closely with boards for more than ten years through our Board leadership programme, supporting the development of a community of non-executive directors in London and beyond. We also work with individual organisations and their boards, delivering tailored programmes to help them handle specific challenges or develop their leadership capacity. On some of these programmes, we have conducted board observations so our leadership experts can provide feedback to the boards on how they are working together.

For more on the Board Leadership programme, visit www.kingsfund.org.uk/blp or contact Katy Steward on k.steward@kingsfund.org.uk

You can see more of our work anticipating the Francis Inquiry report into the failings at the Mid Staffordshire NHS Foundation Trust

This article has been adapted and was first published in The King's Fund's Insight magazine winter 2012.