Board leadership: behaviour in the boardroom

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  • Posted:Wednesday 02 January 2013

We spoke to a chair and two non-executive directors - Cha Patel, Nick Gash and Hattie Llewelyn-Davies - to find out what behaviours you need to effectively run an organisation in the health and social care system. How should a chair and a chief executive work together and what skills do non-executive directors, executive directors and medical leaders need to display?


Ed Macalister-Smith

NHS executive coach,
Comment date
03 January 2013
Interesting video, thank you.

I have just retired after 25 years in the NHS, 13 as a CEO, working with 6 Boards and 9 Chairs. I agree that the Chair ad CEO relationship is pivotal, and all my Chairs would have said the same, but I don't think that all of them really understood the implications of the NHS governance structures...

At the end of the day, the CEO is the Accountable Officer, and is the one (not the Chair) who gets pulled in front of the Public Accounts Committee if something goes wrong. And the Chair appoints the CEO. So if there is a problem with the CEO, the Chair needs to firstly know that there is a problem, and secondly the Chair needs to act.

Some of my Chairs would have been unable to do the necessary... We know this to be more generally true because of the rare but unfortunately regular corporate failures that happen in the NHS.

I applaud the belief that MDs and DNs should lead Board discussions on quality, but again we know that that can occasionally mislead a Board into the belief that everything is OK, when it isn't. Boards need a high level of other assurance.

So my prescription is for a Board that is hugely supportive of the executive, thoroughly engaged in developing strategic direction with the executive, but which at the end of the day takes nothing for granted, and which is willing to act assertively on the basis of other assurance if anything is amiss. The key skill for the Chair is not about being able to steer the ship on a steady course through calm waters, but is about being able to make that critical judgement at a time of crisis (and it will almost always be a judgement, made with very imperfect levels of information).

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