How NHS boards can make their operations more effective

Ask yourself: “How do you make sure your organisation is running effectively?

To deliver the best healthcare, every part of the organisation needs to run smoothly.

And that starts with a healthy board.

Your board sets the direction, it makes the important decisions and it keeps the interest of everyone aligned.

So when your board is running effectively, it sets the tone and the effectiveness will trickle down to the rest of the organisation.

An effective board

Being effective means focusing on doing the right things, instead of doing things right.

And especially because most boards don’t have that much time together, being effective is infinitely more important than anything else.

So in that limited amount of time, the question becomes about how we can…

… increase the quality of the decisions you make during board meetings.

… avoid distractions from things that seem more urgent but are less important.

… collaborate with fellow board members to reduce friction in decision making.

In this article, you’ll discover different aspects of how you can ensure that your board is effective:

“Does this belong in the board meeting?”
Pre-meeting agenda setting
Evaluate supporting documents beforehand
Elicit stakeholders’ insights
Increase engagement during the meeting
Evaluate your decisions
Never stop before listing action points
Prioritise a people strategy
The key to being more effective

“Does this belong in the board meeting?”

Think about this for a second:

How much time during your board meetings is dedicated to making operational decisions vs. developing a strategic direction?

Most NHS boards get stuck on spending too much time on operational issues.

It makes sense, because these seem the most pressing.

But because the board’s time is already so limited, there’s a bigger need to focus on what really matters: strategic initiatives and direction.

And this what the study of ‘Enhancing the performance of NHS boards’ confirms:

High-performing boards have a stronger strategic focus.

Other distractions

Other than not focusing enough on strategic topics, there’s another common topic that overtakes board meeting: repeated discussions already held at subcommittees and in operational meetings.

You’re already struggling enough to move through your agenda. So if there are items that already have been discussed outside of this board meeting, be very strict about pointing that out.

Getting committee structures right
If you get your committee structure right, then you’re more likely to focus on the appropriate topics during each board/committee meeting. That’s why Consulting company GE Healthcare Finnamore recommends “establishing regular reviews not only of Board subcommittees but also the governance structures below that”.

Pre-meeting agenda setting

In any board meeting, there’s constant tension between the number of topics to be discussed and how much time there is to discuss those things.

A company secretary or committee services manager has a lot of power to control what is being discussed during the meeting, well before the meeting actually takes place.

A few weeks in advance of the meeting, he/she can reach out to board members with a preliminary agenda and ask:

Which of these topics should we spend most time on discussing?
What topics (if any) do you feel we should add or remove from the agenda?

Based on the feedback, the final agenda can be set.

During the meeting, the chair has to make sure the only things that are being discussed are according to the agenda.

Evaluate supporting documents beforehand

Once the topics of the meeting have been set in the agenda, the company secretary/committee services manager can ask board members:

“What materials do you need to have seen before being able to make a
sound decision on these topics?”

If you and your other board members commit to reviewing the board pack carefully before arriving at the meeting, you’ll see a number of benefits:

Discussing on each topic will take less long.
The quality of the discussion will increase because everyone is familiar with all the details.
Better decisions will be made.

Elicit stakeholders’ insights

Your board is there to ensure the organisation delivers services that reflect the needs of your communities. So opening up to different stakeholders becomes key.

Most governing bodies open up their board meetings to the public and welcome patients, staff members and the general public to attend.

But that’s not the only way to go.

GE Healthcare Finnamore’s study points out that this is a weak area amongst the NHS Trusts in the study. So don’t feel bad if this is no different for your organisation.

Other ways to get insights into other stakeholders:

Actively engage stakeholders in conversations outside of board meetings
Invite specific people to come and share their expertise/ input
Try an online stakeholder survey to establish where there is room for improvement (just like South Worcestershire (SW) Healthcare did)

Increase engagement during the meeting

Another important aspect to making valuable decisions, is being sharp and having clear thoughts.

How focused can you expect to be if you’ve spent all day in surgery before the meeting? Or if you already sat in 7 hours of meeting before the board meeting started?

With a fresh mind, you can discuss issues more in depth. And that can only improve your ability to make good decisions.

So plan board meetings early in the morning, rather than at the end of a long day.

As the engagement of board members is increased, you’ll see that you’ll also get the most out of everyone’s expertise.

More tips to increase engagement:

Turn off phones during the board meeting
Introduce sanctions for members whose phone rings
Change the table layout to encourage constructive interaction

(Check out this Ultimate Toolbox for other tricks for more effective meetings)

Evaluate your decisions

When the board comes to a decision, you can apply two key tests to verify that it was the right thing to do:

Would you spend your own money this way?
Would you wish to use this service yourself?

According to an NHS chief executive, this is how his organisation ensures they have “the taxpayer on one shoulder and the patient on the other”.

Never stop before listing action points

Nothing is more frustrating than long meetings, without concrete decisions, right?

But you do need to realize that you’re part of the problem and part of the solution.

At the end of the meeting, you should be able to look back at the agenda and list a number of action points for each topic. If you can’t, there better be a good reason.

One way to encourage this behavior is by confirming any decisions made before you close the discussion and move on to the next topic.

Action items guidelines Ensure that action items are expressed as full sentences:
“Translate a summary of the meeting for AAA”, instead of “summary AAA”.

Ensure that all crucial details are included, such as project deadlines, the responsible party and any ensuing action items that are expected to arise from the original one.

Prioritise a people strategy

According to Patients First and Foremost, there is a wealth of evidence which clearly shows that the key to providing safe, effective and compassionate care to patients is supporting and valuing staff.

So to make NHS organisations more effective, the board needs to make this an important aspect in reaching their strategic goals.

NHS Leadership Academy points out that a good people strategy includes a focus on the following domains:

Training and professional development
Workforce model
Leadership and management model
HR health indicators
Values, behaviours and attitudes

The key to being more effective

The last thing that sets apart high-performing boards, is having more explicit structures and processes in place. For the Russell Reynolds team, these structures not only apply to having a clear agenda, but also to: