Over the last 25 years I have been part of a number of Boards in charities, companies and the public sector, as Non-Executive Director (NED), as a senior staff member, and as an external consultant. Having recently become Chair of an NHS Foundation Trust, I’ve been reflecting on the role of Boards – and of NEDs in particular – and the behaviours that can help us deliver excellent governance.

A few years ago, as a NED, I challenged my Board on its process, suggesting that the right decision made in haste, with the wrong governance process, would prove itself to be the wrong decision. Now I would add that the right decision, taken with poor behaviours and values, will prove itself to be the wrong decision.

So how can Boards attend to their governance well? The Nolan Principles of public life should always be the starting point. Its seven principles of Selflessness, Integrity, Objectivity, Accountability, Openness, Honesty, and Leadership are useful headlines, but there are other behavioural questions that should matter to Boards and their NEDs.

 

  1. Do I focus on patients/ service users?

This might seem obvious, but is well worth being explicit about, time and again.

On my office wall is the question How will what I am doing today help improve our patients’ experience? For me, this captures a primary responsibility for NEDs: our focus should always be on the patient or service user. If this focus is applied to, for example, discussions on estate management, or staffing, or finances, or partnership working, it immediately adds an important dimension.

A few years ago Quality, Innovation, Productivity and Prevention (QIPP) programmes were introduced into the NHS. From a commissioner perspective, QIPP was clearly linked to finances: they had significant QIPP savings targets to meet, and this concentrated much of their thinking: How can we do things more cheaply and, in doing so, have a positive impact on patients? At the same time, GPs and other clinical leaders were beginning to form Clinical Commissioning Groups (CCGs) and saw QIPP as a chance to change care pathways and put right things that had been frustrating them for years: How can we do things better for patients, and in doing so have a positive impact on NHS finances?

Whilst both approaches often generated improvements in care and financial savings, I remember being struck by hearing a very experienced commissioner congratulate a CCG on how they were now delivering some of the radical change the NHS needed, precisely because their approach differed to previous commissioning models in genuinely putting patients first.

 

  1. Am I vigilant in taking responsibility and being accountable?

Boards are accountable for what their organisations do and don’t do, and should always act as such. This is particularly true for NEDs. In practice, of course, this does not mean NEDs getting drawn into operational delivery, but is about them taking a strategic overview of operational activity, considering the potential impacts and risks of that activity, and being prepared to be held to account if something goes wrong.

It is easy to say that “tough decisions are needed” (often a shorthand for cutting staff, services, or both). It can be harder for Boards to hold and own the responsibility and accountability for tough decisions, though it is critical that they do so.

NEDs should ask key questions, like:

  • What do I need to know to fully understand the hoped-for – and likely – impacts of this decision?
  • Can I confidently explain why this is the right decision for our patients/ service users as well as for our organisation? If not, what do I need to know in order to be able to do so?
  • How will I know this activity delivers what we say it will? What evidence do I need to see, by when? How will I test the robustness of the evidence?
  • What should I know now, rather than learn only after something goes wrong?

Senior staff are responsible for carrying out the operational mechanics of “tough decisions”. The fact that they do so does not mean they are immune from the personal impact of, for example, workforce reductions meaning people lose their jobs, or service changes that mean patients no longer have access to a service they once did. Once a decision has been taken, NEDs must be clear about their responsibility for it, but also in supporting leaders and other staff in its implementation, clearly owning the decision collectively.

 

  1. Do I give elegant, respectful challenge, and challenge the right things?

Of course Board members should challenge – challenge data, proposals, decisions, and perspectives. But we have a responsibility to do so elegantly and respectfully.

I’ve been on the receiving end of a broad range of Board challenges. The best have left me knowing clearly what the Board needs, where my thinking or activity needs to be different, and, most importantly, what “good” would look like. And, even when the challenge has been robust, I have come away knowing that I was not personally being attacked.

Conversely, I have left Board discussions with proverbial scars on my back, puzzled about what was actually required, having no clarity about how to give the Board what it wanted, and feeling undermined and attacked. Inevitably, the former style of challenge enabled me to give the Board something useful, appropriate, and in line with what they needed, whilst the latter was more likely to result in my next set of proposals also falling short of the Board’s needs!

Elegant, respectful challenging means considering:

  • What am I hoping to achieve from this challenge and how do I structure it so as to increase the chances of it being successful, particularly for those I’m challenging?
  • Am I clearly “tackling the ball, not the player”?
  • Am I being clear enough so that the recipient of my challenge not only understands what I think should be changed, but also understands in what ways it should be changed?
  • Have I clarified what “good” would look like?
  • Am I open to the possibility I might not be right, and open to being challenged back?

And let’s consider what it is we are actually challenging. Yes, it might be helpful for the staff member who has prepared that paper to a hard deadline, perhaps working outside their scheduled hours, to better understand how a paragraph in the cover sheet could be more grammatically correct, but that is probably not the best use of challenge in a Board meeting! Rather, we should be focused on the decisions we need to take, and whether we have sufficient appropriate information in front of us to confidently take that decision.

Good Board cycles enable NEDs to give staff feedback in advance of meetings. The “grammar police” type of feedback is best given outside formal meetings, without distracting from the “real” content. And, if we have questions seeking more information, it is helpful and respectful to raise these in advance, so the recipient can be best placed to answer it fully in the Board, rather than being put on the spot in the meeting. (The other benefit of asking a question outside the meeting is that if I’ve misread the paper or data, this can be explained to me without my mistake having to be pointed out in front of my Board colleagues!)

 

  1. Do I “live the values” of my organisation?

Good organisations have clear statements of their values, of what drives them to do what they do. Boards themselves should reflect the organisation’s values – in how they carry out their business, and are perceived. This means NEDs reflecting on organisational values and periodically asking “What would it look like for me to ‘live’ these values as a NED?”

Boards of organisations professing values of patient focus, equality and diversity, and a culture of learning not blame, should demonstrably frame decisions on what will be best for patients, should reflect on how equality and diversity can enhance its membership, decision-making and attitudes, and show that they learn lessons from their own organisation and others, particularly when things have gone wrong, without scapegoating.

Such a commitment to values does not mean avoiding responsibility for tough decisions or being “soft and fluffy”. Rather, it is a way of helping staff, patients and service users, and others see that values do matter and define the type of organisation the Board leads.

 

  1. Do I recognise others’ achievements?

Some of us are happy to go through life without having others tell us when we’ve done well. I suspect, though, that this is a minority of people, and that most of us thrive better with a bit of positive recognition! Some also say that we shouldn’t expect thanks for “just doing our job”. I disagree. Getting positive feedback about a job well done helps us learn what we do that works well, so we can do more of it. It also shows we are valued in our day-to-day work. Of course, “going the extra mile” should be recognised specifically, but sometimes being seen for “just doing our job” gives a real sense of recognition.

NEDs are in a strong position to demonstrably recognise achievement. This is not only about big award ceremonies, though they can play an important part. More often, it is about saying thank you, and being specific what the thank you is for. A generic “thank you for your work” is good. A specific thank you for the way in which a staff member helped improve a patient’s experience is even better.

 

  1. Do I focus on patients/ service users?

Yes, I know this is the same as my first point, but it bears repeating, and can constructively be reflected on at the end of an activity, as well as at the beginning: How has what I have been doing today helped improve our patients’ experience?

In writing this, I have been reflecting on my approach to Board-level work.

Getting it right as a NED means striving to get it right for our patients. If I continue to view my Board activity through a lens of improving patient experience, and challenging myself on my own behaviours, I believe this will help me and my Board take good decisions.