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In the light of failings of the board highlighted by the mid Staffordshire NHS Foundation Trust public inquiry, this paper seeks to offer insights about how boards in general might develop in order to discharge their responsibilities for quality and safety in health care more consistently in the future. The paper also proposes to examine wider questions about the role, purpose, and impact of boards on organisations.

The paper draws on literature from across the social sciences to assess the evidence for effective board working using a contingency and realist approach.

The examination leads to the identification of three key issues surrounding the construction and the development of boards. First, there is no evidence or consensus about an “ideal” board form. The rationale and evidence‐base, for example for the 1991 model for NHS boards in the English NHS, has never been set out in an adequate manner. Second, the evidence about effective board working suggests that there are some key principles but also that local circumstances are really important in steering the focus and behaviours of effective boards. Third, there is an emerging proposition that boards, including in healthcare, need to embody a culture of high trust across the executive and non executive divide, together with robust challenge, and a tight grip on the business of delivering high quality patient care in a financially sustainable way (high trust – high challenge – high engagement).

The paper argues that it is advisable to move away from a tendency to faith‐based and exhortative approaches to guidance, training and development of boards and that it is time for a root‐and‐branch inquiry into the composition, structure, processes and dynamics of healthcare boards in the interests of assuring patient safety.

This study explores key governance, leadership and management activities that have impact on quality, risk and safety within Australian healthcare organisations.

Current non-executive directors (n = 12) of public and private health boards were interviewed about contemporary approaches to fiduciary and corporate responsibilities for quality assurance and improvement outcomes in the context of risk and safety management for patient care. Verbatim transcripts were subjected to thematic analysis triangulated with Leximancer-based text mining.

Boards operate in a strong legislative, healthcare standards and normative environment of quality and risk management. Support and influence that create a positive quality and risk management culture within the organisation, actions that disseminate quality and risk broadly and at depth for all levels, and implementation and sustained development of quality and risk systems that report on and contain risk were critical tasks for boards and their directors.

Findings from this study may provide health directors with key quality and risk management agenda points to expand or deepen the impact of governance around health facilities' quality and risk management.

This study has identified key governance activities and responsibilities where boards demonstrate that they add value in terms of potential improvement to hospital and health service quality care outcomes. The demonstrable influence identified makes an important contribution to our understanding of healthcare governance.

The importance of hospital board engagement in the work of governing healthcare quality has been demonstrated in the literature. Research into influences on effective corporate governance has traditionally focused on board architecture. Emerging research is bringing to light the importance of governance dynamics. This paper contributes to emerging research through highlighting how communication and leadership underpin effective engagement in governing healthcare quality.

A comparative case study of eight Australian public hospitals was undertaken involving document review, interviews and observations. Case studies were allocated into high- or low-engagement categories based on evidence of governance processes being undertaken, in order to compare and contrast influencing factors. Thematic analysis was undertaken to explore how communication and leadership influence healthcare governance.

Several key components of communication and leadership are shown to influence healthcare quality governance. Clear logical narratives in reporting, open communication, effective questioning and challenge from board members are important elements of communication found to influence engagement. Leadership that has a focus on healthcare excellence and quality improvement are aligned and promote effective meeting processes is also found to foster governance engagement. Effective engagement in these communication and leadership processes facilitate valuable reflexivity at the governance level.

The findings highlight the way in which boards and senior managers can strengthen governance effectiveness through attention to key aspects of communication and leadership.

The case study approach allows the exploration of communication and leadership in greater depth than previously undertaken at the corporate governance level in the healthcare setting.

A key question in the provision of public health concerns how that provision is governed. The purpose of this paper is to examine the governance structure of a public health board and its perceived impact on the efficacy of clinical operations.

Structural issues examined the level of centralisation and public participation, and whether governance should occur through elected boards or appointed managers. These issues were examined through multiple lenses. First was the intention of the structure, examining the issues identified by parliament when the new structure was created. Second, the activities of the board were examined through an analysis of board meetings. Finally, hospital clinicians were surveyed through semi-structured interviews with both quantitative and qualitative questioning.

A contradiction was revealed between intention, perception and actual activities. This raises concerns over whether the public are significantly informed to elect the best-skilled appointees to governance positions.

This research holds implications for selecting governance structures of public health providers.

Few studies have looked at the role of a publicly elected healthcare governance structure from the perspective of the clinicians. Hence, this study contributes to the literature on healthcare structure and its impact on clinical operations, by including a clinician’s perspective. However, this paper goes beyond the survey and also considers the intention of the structure as proposed by parliament, and board activities or what the board actually does. This enables a comparison of intention with outcomes and perception of those outcomes.

This study aims to analyse the line managers and employees’ use of lean task boards over time in Norwegian municipalities using action learning theory. The research question was the following: what kind of action learning processes do the line managers and employees’ use of the lean task board promote in municipalities’ healthcare units?

This qualitative case study data from a Norwegian municipality involved analyses of 750 internal self-recorded logs from task board sessions from 6 different units and 25 semi-structured interviews of managers and employees.

The task board works for line managers to make employees responsible for forwarding ideas, solutions and implementation of new actions. The use of the task boards contributes to systemising work through establishing new routines and improving orderliness at work. The line managers used the task boards as a project management system to track progress in the purchasing of diverse equipment and initiatives to improve professionalism and their units’ facilities. The study explains the learning challenges for managers using the lean task board, as the method promotes finding experience-based solutions that do not involve critical reflection and use of theory.

The lean task board is well-suited for managers to promote learning processes that counteract chaos in local healthcare organisations. However, the task board has limitations as a method for improving services amongst healthcare units and for solving difficult problems.

The study contributes to understanding how action learning theory can be applied to the analysis of the results of lean task board sessions

The purpose of this paper is to provide an overview of the state of clinical governance practices globally as well as a more detailed examination of the clinical governance landscape in Canada. The paper explores the concept that established clinical governance practices are more important than ever as healthcare systems are increasingly under pressure to reduce costs while dealing with the challenges of ageing populations. Additionally, it suggests that healthcare could benefit by studying and adopting some of the successful governance policies that exist in other jurisdictions or sectors where quality and safety are an integral part of their governance mandate, such as the airline or nuclear energy sectors.

This paper explores the status of clinical governance practices in Canada. This is achieved through a combination of author experience in addition to the review of existing literature and assessments on clinical governance practices and patient safety.

While individual success stories can be found, standardized clinical governance practices across the range of healthcare providers remain largely absent. By focussing on standardized processes, and by placing an emphasis on improved clinical governance, healthcare providers can control and in some cases lower costs while improving efficiency and increasing patient safety. While progress has been slow for many years, the authors speculate that healthcare has reached a tipping point. As information systems develop and become more reliable and robust, and systems move to a patient-centric collaborative approach to care, there is a tremendous opportunity for healthcare and life sciences organizations to exploit and capitalize on both their growing information repositories, and the big data trends that have been embraced and leveraged by other sectors in recent years.

Managing costs and delivering safe, efficient care to patients remain top considerations for healthcare boards and healthcare systems alike. As healthcare systems grapple with the increasing costs and risk associated with ageing populations and a more complex healthcare delivery model, effective clinical governance policies focussed on quality outcomes are essential.

This paper highlights the responsibility of healthcare boards to learn lessons from other safety-critical industries and develop their own capacity to evaluate progress toward the goals identified above. It also provides insight into the role that leaders on both the corporate and clinical sides of the industry have to play, and the need for meaningful measures that will drive a quality agenda. The paper also emphases the link between established clinical governance practices and greater efficiency, reduced costs and improved patient safety.

The purpose of the study is to examine how Non-Executive Directors (NEDs) in the English National Health Service (NHS) commissioning bodies experienced their role and contribution to governance.

Semi-structured interviews were conducted with a purposive sample of 31 NEDs of Primary Care Trusts (PCTs) and 8 Clinical Commissioning Group (CCG) NEDs. Framework analysis was applied using a conceptualisation of governance developed by Newman, which has four models of governance: the hierarchy, self-governance, open systems and rational goal model.

NEDs saw themselves as guardians of the public interest. NEDs’ power is a product of the explicit levers set out in the constitution of the board, but also how they choose to use their knowledge and expertise to influence decisions for, as they see it, the public good. They contribute to governance by holding to account executive and professional colleagues, acting largely within the rational goal model. CCG NEDs felt less powerful than in those in PCTs, operating largely in conformance and representational roles, even though government policy appears to be moving towards a more networked, open systems model.

This is the first in-depth study of NEDs in English NHS local commissioning bodies. It is of value in helping to inform how the NED role could be enhanced to make a wider contribution to healthcare leadership as new systems are established in the UK and beyond.

This paper describes a quality improvement project to improve oversight of quality at national board level using statistical process control (SPC) methods, complimented by a qualitative experience of patients and frontline staff. It demonstrates the application of the “Picture-Understanding-Action” approach and shares the lessons learnt.

Using co-design and applying the “Picture-Understanding-Action” approach, the project team supported the directors of the Irish health system to identify and test a qualitative and quantitative picture of the quality of care across the health system. A “Quality Profile” consisting of quantitative indicators, analysed using SPC methods was used to provide an overview of the “critical few” indicators across health and social care. Patient and front-line staff experiences added depth and context to the data. These methods were tested and evolved over the course of six meetings, leading to quality of care being prioritised and interrogated at board level.

This project resulted in the integration of quality as a substantive and prioritised agenda item. Using best practice SPC methods with associated training produced better understanding of performance of the system. In addition, bringing patient and staff experiences of quality to the forefront “people-ised” the data.

The application of the “Picture-Understanding-Action” approach facilitated the development of a co-designed quality agenda item. This is a novel process that shifted the focus from “providing” information to co-designing fit-for-purpose information at board level.

As a profession, healthcare management values commitment to lifelong learning and continuous professional development. Individual participation, however, is voluntary and healthcare managers choose to participate based in part on perceptions of organizational support (rewards, promotion and recognition) as well as on individual values. As women are narrowing the career attainment gap, participation in development activities may play a critical role. This paper aims to present a pilot study which assesses the differences in male and female healthcare managers' participation in professional development activities and perceived organizational support.

An exploratory survey was emailed to current and past members of three professional associations who share similar missions “to provide educational and networking opportunities” for their members in the southern region of Florida.

The findings suggest that women healthcare managers are less likely to pursue professional development activities than their male counterparts even when the outcome (i.e. obtaining professional certification) is associated with career advancement and salary increases. Furthermore, men are more likely than women to attend multiple continuing education programs when paying out of pocket.

This pilot study is one of the first attempts to account for the factors that explain gender differences in pursuing personal development activities. Rather than conclusive judgments, it provides directions for further research.

As professional and leadership competencies become more ingrained in the industry, women may need to recognize and commit to development activities associated with healthcare leadership and management.

Competencies gained through professional development activities may impact career attainment.