Better boards for healthcare – map the gap with best practice

You sit on the board of a healthcare provider. In the UK much of that comes in the National Health Service, though increasingly bits of the work are done in the private and charitable sectors of the economy. You have a responsibility to look after the provider's financial resources, much or even all of which comes from taxpayers. You have a responsibility for the care of patients, too. This is, therefore, not just an exercise in maximising the return on shareholder equity or other narrow definitions of corporate governance. What does the board do?

The Institute of Chartered Secretaries and Administrators in the UK has been trying to find out what actually happens in the boards of NHS trusts, the bodies that oversee the hospitals funded directly from government. It organised an online survey of trust directors and secretaries, observed about 20 boards in action and reviewed the board papers for more than 1,200 board meetings. What it found wasn't very encouraging:

• Lack of strategic focus: There was little discussion of strategy. Outside directors felt their primary role was holding the executive team to account, so only 10 per cent of the agenda dealt with strategic issues, compared with 60 per cent with recommendations for best practice. Most of the rest of the items, by the way, were issues in patient care.
  
• Indecision: The observations showed little evidence of challenge, board papers were of "variable quality" and boards were presented with far more item "to note" than to decide.
  
• Transparency: Only one per cent of respondents thought that giving the public a say in shaping services was a priority for the board. Nor would having open board meetings be a good way to increase accountability. Bear in mind that government reforms under consideration now have targeted open board meetings as mandatory.

And more. There are issues with the methodology that raise some questions, but ICSA argues that the findings are "directionally valid" if not "statistically valid". There are reasons to question some of findings. Board agendas, for example, have items "to note" where regulation prescribes that board "note" something. They may not occupy any time at all in an actual board meeting. But the study suggests that things aren't quite ideal on boards – yet another area where the public sector is following the lead of private-sector companies.

Source document: The ICSA study "Mapping the gap: Highlighting the disconnect between governance best practice and reality in the NHS," is a 48-page pdf file.