health service boards
The term governance has only relatively recently gained currency as a distinct entity within the study of the management of organisations. The development of the debate around governance can be largely traced to incidents relating to the high profile organisation failures of the early 1990s (Maxwell, Polly Peck, Barings Bank), the US corporate scandals (Enron, WorldCom) a few years later and which have continued on into this decade (Equity Life, Parmalat). These examples demonstrate that the problem is international. The responses to these events have provided much of the impetus for clarifying concepts of 'good governance and have also framed the discussions around the management of corporate risk. This chapter examines the impact of the governance debate on the management of health services, outlines different board models and analyses the evolving role of boards of health organisations. Many examples used relate to the English NHS but reference is also made to other health systems, and the discussion is in addition framed within the wider context of debates around the role of boards.
Three main strands of argument will be developed; first that the governance debate is largely overshadowed by notions of control and that this impacts significantly on health service governance; second, that there is some consensus that board structures and forms matter less than choices around behaviours and clarity of purpose; third, that despite extensive elaborations of the roles of boards there are enduring concerns about board performance. A putative framework will be outlined for developing effective boards, based on a study in the English NHS but with relevance for other types of boards and other health systems. The chapter will end by arguing that boards do matter, but we need better ways of expressing why this is the case, and that research is required to find out exactly how they make a difference to organisational performance.