Interaction between non-executive and executive directors in English National Health Service trust boards: An observational study

Abstract

Background: National Health Service (NHS) trusts, which provide the majority of hospital and community healt services to the English NHS, are increasingly adopting a 'public firm' model with a board consisting of executiv directors who are trust employees and external non-executives chosen for their experience in a range of areas suc as finance, health care and management. In this paper we compare the non-executive directors' roles and interest in, and contributions to, NHS trust boards' governance activities with those of executive directors; and examin non-executive directors' approach to their role in board meetings Methods: Non-participant observations of three successive trust board meetings in eight NHS trusts (primary car trusts, foundation trusts and self-governing (non-foundation) trusts) in England in 2008-9. The observational dat were analysed inductively to yield categories of behaviour reflecting the perlocutionary types of intervention whic non-executive directors made in trust meetings Results: The observational data revealed six main perlocutionary types of questioning tactic used by non-executiv directors to executive directors: supportive; lesson-seeking; diagnostic; options assessment; strategy seeking; an requesting further work. Non-executive board members' behaviours in holding the executive team to account a board meetings were variable. Non-executive directors were likely to contribute to finance-related discussion which suggests that they did see financial challenge as a key component of their role Conclusions: The pattern of behaviours was more indicative of an active, strategic approach to governance than o passive monitoring or 'rubber-stamping'. Nevertheless, additional means of maintaining public accountability o NHS trusts may also be required.