Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence

Background: Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in developing the safety of these organisations. However, recent attention has been drawn to boards’ ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of interest.
Methods: the article draws on a series of 10 interviews with key informants and policy actors who form part of the ‘issue network’ interested in the promotion of patient safety in the English National Health Service.
Results: the interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated and refined the theoretical perspectives trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on ‘trust’ characterised leadership styles and behaviours attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of ‘intelligence’ from both national and locally generated information sources.
Conclusions: We call for a re-imagination of hospital board oversight in the light of these different perspectives and anticipate an emerging research agenda in this area.

© 2015 Millar et al. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.