We have to go back to the Thatcher years to find the origins of NHS establishments being run by Boards.
Frustrated by poor NHS management, highlighted in the Griffiths Report, morphing hospitals into Trusts, though hoops and hurdles of qualification, was designed to make them run in a more ‘business-like’ way.
Hence, The Board.
It was only fierce lobbying from trades unions that nurse and medical directors emerged as members. Furthermore, it was never envisaged the non-executive members would be drawn from the ranks of councillors and the like and no guarantee they should be local. It was experience and skills that counted.
Over time Boards have changed direction, composition and recruitment. The NHS changed, the environment in which they conduct their business, unrecognisable. No NHS group can exist without the panoply of a Board. Whatever the cost.
… and what a cost. Averagely; ChEx, ND, FD, HR all costing around £200k a year each. Plus 5 NEDs @ £6k and a Chair at maybe £23k.
Usually, the most expensive, the Medical Director, could still be in practice, senior with merit awards and fee for being a board member, well over £250k.
Plus, administrative support, IT and all the rest.
Has the time has come to think again?
Boards, haven’t covered themselves in glory. Catastrophic safety and quality failures, collapsed balance sheets.
The role of medical and nurse directors has to be questioned, given the variation in care and outcomes GIRFT is revealing.
Chief executives, recycled. The non-executive community, all but invisible.
In fairness, it’s a broad history, from; success, a willingness to engage and be visible through to incompetence and hiding.
There are few ways to evaluate how well a board is doing, until disaster strikes.
Governance and procedures, guidance and regulation appears to be no guarantee of a Board’s success.
How prepared is the average Board member? What is their grasp of arcane NHS finance. How well do they understand the implications of workforce shortages? Do they really know what a grasp of data could do for their organisation?
I would bet the farm, 25% of board members do not fully appreciate the complexity of the organisations they oversee. Hence, individual responsibility is dissolved in large groups and the biggest danger facing Boards; ‘groupthink…’
… someone suggests something, you think it’s a bad idea but the others go along with it. Do you go along, or go against?
I know of no NHS board that routinely subjects itself to performance evaluation and its decisions to audit.
This is a far bigger problem than just the NHS.
Interesting case studies;
The misfortunes of the US giant K-Mart who had half a dozen Fortune 500 chief executives on their board…
Carillion; eleven of the most talented and experienced Directors you could possibly assemble.
Point made? Whopping pay, wide experience, no guarantee of success or solvency.
Whatever skills Boards have is no substitute for insight, intuition and ‘nouse’.
Should Boards be reinvented for today’s NHS? Does every organisation need one? How should we populate them?
A chief executive, technical skills? No, a leader, with people skills, maybe elected by the staff? Why leave it to the mysterious head-hunters?
A finance person? Of course but how about seconding them from industry or the Treasury?
If we are to have medical and nurse directors, we cannot deny a place on the Board for physio-directors, porter-directors, catering-directors and every other skill.
Instead, how about we start with the patient and work-back; a director of patient safety and satisfaction.
A worker director, elected by the workforce. And, without doubt, a red-hot digital-information analyst.
Would these changes make for better Boards?
Good Boards are robust, they respect each other, trust each other in an environment of candour. They don’t look for blame they look for cause and celebrate success. They all have the same information, challenge each other and bring flexibility to the table.
Eisenhardt and Bourgeois write;
‘…the highest-performing companies have extremely contentious boards that regard dissent as an obligation and treat no subject as undiscussable.’
Who are we looking for when we select a Board member? I’d hire someone who said;
‘I don’t think you want me on your board, because I am contentious. I ask a lot of questions and if I don’t get the answers, I won’t sit down.’
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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.