A (new) model of board of directors: evidence from the National Health Service

Purpose – The paper aims to investigate the collective behaviour of boards of directors in 22 English National Health Service trusts and how this impacts on the exercise of their role and functions. Furthermore, it aims to shed light on the governance model characterising boards of health sector organisations.
Design/methodology/approach – The data were gathered using a range of qualitative techniques (96 semi-structured interviews, focus groups, workshops and document analysis) with a multiple case study approach.
Findings – Owing to the existence of overlapping governance ideologies, health care boards are characterised by different internal dynamics, processes and levels of engagement in the exercise of their tasks. Post-new public management driven boards emphasise a pronounced collective approach in
their internal proceedings, a wider perspective in strategising and a greater stakeholder involvement in decision-making processes. These characteristics are particularly evident in boards of foundation trusts, in which network driven governance principles and mechanisms receive a more comprehensive
implementation through a collective leadership approach.
Practical implications – The model of the board shared by foundation trusts moves these health care organisations closer to the idea of social enterprises. Additionally, the evidence shows similar behavioural characteristics between these boards and the best practice examples of private sector boards.
Originality/value – The foundation trust model of the board provides new meaningful connotations and significance to the traditional understanding of health care boards, offering a more comprehensive notion of their role and functions in terms of leadership provision, strategy formulation, monitoring
and reporting.