Overseeing oversight: governance of quality and safety by hospital boards in the English NHS

Objectives:
To contribute towards an understanding of hospital Board composition and oversight of patient safety and health care quality in the NHS.
Methods:
A review of the theory related to hospital Board governance and two national surveys undertaken about Board management in NHS hospital trusts in England. The first was issued to 150 Trusts in 2011/12 and completed online via a dedicated web tool. A total of 145 replies were received (97% response rate). The second online survey undertaken in 2012/13 targeted individual Board members using the Board Self Assessment Questionnaire (BSAQ). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS Trusts then in existence (66% response rate).
Results:
Around 42% of Boards had 10-12 members and around 51% had 13-15 members. We found no significant difference in Board size between Foundation and non Foundation trusts. Around 62% of Boards had three or fewer serving Board members with clinical backgrounds. For about two-thirds of the Trusts (63%), Board members with a clinical background comprised less than 30% of the Board members. Boards were using a wide range of hard performance metrics and soft intelligence to monitor their organisation with regard to patient safety. Hard, quantitative data were reportedly used at every Board meeting across most hospital Trusts (>80%), including a range of clinical outcomes measures, infection rates and process measures such as medication errors and readmission rates. A much smaller proportion of Trusts (57%) routinely report morbidity rates at every Board meeting. Softer intelligence, used organisationally and reported at all Board meetings, was more variably reported, with discussions with clinicians (in 89% of Trusts) and executive walk-arounds (88%) being most often reported, alongside use of patient stories (83%). However, in only about two-thirds of Trusts did Board members shadow clinicians and report back to the Board (65%). The BSAQ data showed general high or very high levels of agreement with desirable statements of practice in each of the six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (interpersonal) to 85% (political).
Conclusions:
The study provides the best account to-date of English NHS Boards and their actions around health care quality and patient safety. While systematic differences between Trusts of different types were rare, there was nonetheless variation between individual Trusts on both Board composition and Board practices. These findings lay the groundwork for further empirical research exploring the dynamics, influences and impacts of Boards.

Russell Mannion, Huw Davies, Tim Freeman, Ross Millar, Rowena Jacobs, Panos Kasteridis, Overseeing oversight: governance of quality and safety by hospital boards in the English NHS, Journal of Health Services Research & Policy, Vol 20, Issue 1_suppl, pp. 9 - 16 © 2014 (The Authors). Reprinted by permission of SAGE Publications.