Meta-regulation meets deliberation: situating the governor within NHS foundation trust hospitals

Article


Millar, R., Freeman, T., Mannion, R. and Davies, H. 2019. Meta-regulation meets deliberation: situating the governor within NHS foundation trust hospitals. Journal of Social Policy. 48 (3), pp. 595-613. https://doi.org/10.1017/S0047279418000739
TypeArticle
TitleMeta-regulation meets deliberation: situating the governor within NHS foundation trust hospitals
AuthorsMillar, R., Freeman, T., Mannion, R. and Davies, H.
Abstract

NHS Foundation Trust (FT) Hospitals in England have complex internal governance arrangements. They may be considered to exhibit meta-regulatory characteristics to the extent that Governors are able to promote deliberative values and steer internal governance processes towards wider regulatory goals. Yet, while recent studies of NHS FT Hospital governance have explored the role and experience of FT Governors and examined FT hospital Boards to consider executive oversight, there is currently no detailed investigation of interactions between Governors and members of hospital Boards. Drawing on observational and interview data from four case-study sites, we trace interactions between the actors involved; explore their understandings of events; and consider the extent to which the benefits of meta-regulation were realised in practice. Findings show that while Governors provided both a conscience and contribution to internal and external governance arrangements, the meta regulatory role was largely symbolic and limited to compliance and legitimation of executive actions. Thus while the meta-regulatory ‘architecture’ for Governor involvement may be considered effective, the soft intelligence gleaned and operationalised may be obscured by ‘hard’ performance metrics which dominate processes and priority setting. Governors were involved in practices that symbolised deliberative involvement but resulted in further opportunities for legitimising executive decisions.”

LanguageEnglish
PublisherCambridge University Press
JournalJournal of Social Policy
ISSN0047-2794
Electronic1469-7823
Publication dates
Online05 Nov 2018
Print01 Jul 2019
Publication process dates
Deposited26 Sep 2018
Accepted24 Sep 2018
Output statusPublished
Accepted author manuscript
Copyright Statement

This article has been accepted for publication in a revised form in Journal of Social Policy (https://www.cambridge.org/core/journals/journal-of-social-policy) https://doi.org/10.1017/S0047279418000739. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. Copyright: © Cambridge University Press 2018

Digital Object Identifier (DOI)https://doi.org/10.1017/S0047279418000739
Web of Science identifierWOS:000472582100009
Permalink -

https://repository.mdx.ac.uk/item/87yvx

  • 42
    total views
  • 11
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Self-surveillance practices of factory women migrant workers receiving SRH interventions in Malaysia: The effects of salience, gendered subjectivity and universalism
Freeman, T., Miles, L. and Ying, K. 2024. Self-surveillance practices of factory women migrant workers receiving SRH interventions in Malaysia: The effects of salience, gendered subjectivity and universalism. Economic and Industrial Democracy. https://doi.org/10.1177/0143831X231225098
Migrant workers navigating the Covid-19 pandemic in the UK: Resilience, reworking and resistance
Miles, L., Freeman, T., Polzin, A., Reitz, R. and Croucher, R. 2023. Migrant workers navigating the Covid-19 pandemic in the UK: Resilience, reworking and resistance. Economic and Industrial Democracy. https://doi.org/10.1177/0143831X231199874
A handbook to support the sexual and reproductive health needs of factory women migrant workers
Miles, L., Endut, N., Freeman, T., Ying, K., Lai, W. and Mat-Yasin, S. 2022. A handbook to support the sexual and reproductive health needs of factory women migrant workers. Pulau Pinang, Malaysia Unit for Research on Women and Gender (KANITA), Universiti Sains Malaysia.
Empowerment as a pre-requisite to managing and influencing health in the workplace: the sexual and reproductive health needs of factory women migrant workers in Malaysia
Miles, L., Freeman, T., Lai, W., Mat-Yasin, S. and Ying, K. 2022. Empowerment as a pre-requisite to managing and influencing health in the workplace: the sexual and reproductive health needs of factory women migrant workers in Malaysia. Economic and Industrial Democracy. 43 (4), pp. 1676-1698. https://doi.org/10.1177/0143831x211024725
Sexual and reproductive health (SRH) of women migrant workers in the ASEAN region: a systematic narrative review and synthesis
Freeman, T., Miles, L., Mat-Yasin, S., Ying, K. and Lai, W. 2021. Sexual and reproductive health (SRH) of women migrant workers in the ASEAN region: a systematic narrative review and synthesis. 19th ILERA World Congress: Making and Breaking Boundaries in Work and Employment Relations. Lund, Sweden [Online] 22 - 24 Jun 2021
At the limits of "capability": The sexual and reproductive health of women migrant workers in Malaysia
Freeman, T., Miles, L., Ying, K., Mat Yasin, S. and Lai, W. 2021. At the limits of "capability": The sexual and reproductive health of women migrant workers in Malaysia. Sociology of Health & Illness. 45 (5), pp. 947-970. https://doi.org/10.1111/1467-9566.13323
Do Hospital Boards matter for better, safer, patient care?
Mannion, R., Davies, H.T.O., Jacobs, R., Kasteridis, P., Millar, R. and Freeman, T. 2017. Do Hospital Boards matter for better, safer, patient care? Social Science & Medicine. 177, pp. 278-287. https://doi.org/10.1016/j.socscimed.2017.01.045
Decentring patient safety governance: case studies of four English Foundation Trust Hospital Boards
Freeman, T., Millar, R., Mannion, R. and Davies, H. 2017. Decentring patient safety governance: case studies of four English Foundation Trust Hospital Boards. in: Bevir, M. and Waring, J. (ed.) Decentred Health Policy: Learning from British Experiences in Healthcare Governance London, UK Routledge. pp. 70-89
Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies
Mannion, R., Freeman, T., Millar, R. and Davies, H. 2016. Effective board governance of safe care: a (theoretically underpinned) cross-sectioned examination of the breadth and depth of relationships through national quantitative surveys and in-depth qualitative case studies. Health Services and Delivery Research. 4 (4). https://doi.org/10.3310/hsdr04040
Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England
Freeman, T., Millar, R., Mannion, R. and Davies, H. 2016. Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England. Sociology of Health & Illness. 38 (2), pp. 233-251. https://doi.org/10.1111/1467-9566.12309
An adult social care compendium of approaches and tools for organisational change
Miller, R., Freeman, T., Davidson, D. and Glasby, J. 2015. An adult social care compendium of approaches and tools for organisational change. Birmingham, UK Birmingham University.
Ethics and spirituality in the workplace: the growing role of the business case in reforms
Freeman, T., Kunter, A., Douglas, C. and Roper, I. 2015. Ethics and spirituality in the workplace: the growing role of the business case in reforms. Human Resource Management International Digest. 23 (5), pp. 43-44. https://doi.org/10.1108/HRMID-05-2015-0092
Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence
Millar, R., Freeman, T. and Mannion, R. 2015. Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Services Research. 15 (1). https://doi.org/10.1186/s12913-015-0771-x
Overseeing oversight: governance of quality and safety by hospital boards in the English NHS
Mannion, R., Davies, H., Freeman, T., Millar, R., Jacobs, R. and Kasteridis, P. 2015. Overseeing oversight: governance of quality and safety by hospital boards in the English NHS. Journal of Health Services Research & Policy. 20 (1 supp), pp. 9-16. https://doi.org/10.1177/1355819614558471
Hospital board oversight of patient safety: a narrative review & synthesis of recent empirical research
Millar, R., Mannion, R., Freeman, T. and Davies, H. 2013. Hospital board oversight of patient safety: a narrative review & synthesis of recent empirical research. The Milbank Quarterly. 91 (4), pp. 738-770. https://doi.org/10.1111/1468-0009.12032
Priority setting and rationing in health care: evidence from the English NHS
Robinson, S., Williams, I., Dickinson, H. and Freeman, T. 2012. Priority setting and rationing in health care: evidence from the English NHS. Social Science & Medicine. 75 (12), pp. 2386-2393. https://doi.org/10.1016/j.socscimed.2012.09.014
Comparing the content of leadership theories and managers' shared perceptions of effective leadership: a Q-method study of trainee managers in the English NHS
Freeman, T. 2013. Comparing the content of leadership theories and managers' shared perceptions of effective leadership: a Q-method study of trainee managers in the English NHS. Health Services Management Research. 26 (2-3), pp. 43-53. https://doi.org/10.1177/0951484813513245
Priority-setting and rationing in healthcare: evidence from the English experience
Robinson, S., Williams, I., Dickinson, H., Freeman, T. and Rumbold, B. 2012. Priority-setting and rationing in healthcare: evidence from the English experience. Social Science & Medicine. 75 (12), pp. 2386-2393. https://doi.org/10.1016/j.socscimed.2012.09.014
Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England
Robinson, S., Dickinson, H., Freeman, T., Rumbold, B. and Williams, I. 2012. Structures and processes for priority-setting by health-care funders: a national survey of primary care trusts in England. Health Services Management Research. 25 (3), pp. 113-120. https://doi.org/10.1258/hsmr.2012.012007
Resource scarcity and priority-setting: from management to leadership in the rationing of health care?
Dickinson, H., Freeman, T., Robinson, S. and Williams, I. 2011. Resource scarcity and priority-setting: from management to leadership in the rationing of health care? Public Money & Management. 31 (5), pp. 363-370. https://doi.org/10.1080/09540962.2011.598352
Disinvestment in health— the challenges facing general practitioner (GP) commissioners
Robinson, S., Dickinson, H., Freeman, T. and Williams, I. 2011. Disinvestment in health— the challenges facing general practitioner (GP) commissioners. Public Money & Management. 31 (2), pp. 145-148. https://doi.org/10.1080/09540962.2011.560714
Reflections on leadership and place
Mabey, C. and Freeman, T. 2010. Reflections on leadership and place. Policy Studies. 31 (4), pp. 505-522. https://doi.org/10.1080/01442871003723465
Performing leadership: towards a new research agenda in leadership studies?
Peck, E., Freeman, T., Six, P. and Dickinson, H. 2009. Performing leadership: towards a new research agenda in leadership studies? Leadership. 5 (1), pp. 25-40. https://doi.org/10.1177/1742715008098308
Performing governance: A partnership board dramaturgy
Freeman, T. and Peck, E. 2007. Performing governance: A partnership board dramaturgy. Public Administration. 85 (4), pp. 907-929. https://doi.org/10.1111/j.1467-9299.2007.00683.x
'Best practice' in focus group research: Making sense of different views
Freeman, T. 2006. 'Best practice' in focus group research: Making sense of different views. Journal of Advanced Nursing. 56 (5), pp. 491-497. https://doi.org/10.1111/j.1365-2648.2006.04043.x
Evaluating partnerships: A case study of integrated specialist mental health services
Freeman, T. and Peck, E. 2006. Evaluating partnerships: A case study of integrated specialist mental health services. Health and Social Care in the Community. 14 (5), pp. 408-417. https://doi.org/10.1111/j.1365-2524.2006.00658.x
Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England
Freeman, T. and Walshe, K. 2004. Achieving progress through clinical governance? A national study of health care managers' perceptions in the NHS in England. Quality and Safety in Health Care. 13 (5), pp. 335-343. https://doi.org/10.1136/qshc.2002.005108
Measuring progress in clinical governance: Assessing the reliability and validity of the Clinical Governance Climate Questionnaire
Freeman, T. 2003. Measuring progress in clinical governance: Assessing the reliability and validity of the Clinical Governance Climate Questionnaire. Health Services Management Research. 16 (4), pp. 234-250. https://doi.org/10.1258/095148403322488937
Using performance indicators to improve health care quality in the public sector: A review of the literature
Freeman, T. 2002. Using performance indicators to improve health care quality in the public sector: A review of the literature. Health Services Management Research. 15 (2), pp. 126-137. https://doi.org/10.1258/0951484021912897
Organisational strategies for changing clinical practice: How trusts are meeting the challenges of clinical governance
Wallace, L.M., Freeman, T., Latham, L., Walshe, K. and Spurgeon, P. 2001. Organisational strategies for changing clinical practice: How trusts are meeting the challenges of clinical governance. Quality in Health Care. 10 (2), pp. 76-82. https://doi.org/10.1136/qhc.10.2.76
The external review of quality improvement in health care organizations: A qualitative study
Walshe, K., Wallace, L., Freeman, T., Latham, L. and Spurgeon, P. 2001. The external review of quality improvement in health care organizations: A qualitative study. International Journal for Quality in Health Care. 13 (5), pp. 367-374. https://doi.org/10.1093/intqhc/13.5.367
Clinical governance. Scope to improve
Walshe, K, Freeman, T, Latham, L, Spurgeon, P and Wallace, L 2000. Clinical governance. Scope to improve. Health Service Journal. 110 (5728), pp. 30-32.