Who should serve on health care boards? What should they do and how should they behave? A fresh look at the literature and the evidence

CITATION

Chambers, N., Harvey, G., & Mannion, R. (2017). Who should serve on health care boards? What should they do and how should they behave? A fresh look at the literature and the evidence. Cogent Business & Management, 4(1).

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ABSTRACT
Public boards of directors face challenges in demonstrating effectiveness and
return on investment. Health care boards in particular operate in a high risk service and
political environment, where both patient safety and financial sustainability are paramount.
The motivation in this article is to make sense of the conflicting and competing
theories which explain the purpose of boards, and the sometimes weak and contradictory
evidence for effective board practices. The main contributions of the study are,
first, the use of a realist approach to understand underlying assumptions behind the
main theories for health care boards, and, second, practical suggestions in relation to
board composition, focus and behaviours, according to circumstances. Amongst its
conclusions, this review indicates that board size should be limited, especially for newer
organisations, physicians on boards are associated with better quality of clinical care,
and choosing to operate diligently with a focus on strategy and on monitoring, a close
grip on the business, and strong support for executives are all important.


REFERENCES
Adams, R., & Ferreira, D. (2009). Women in the boardroom and
their impact on governance and performance. Journal of
Financial Economics, 94, 291–309.

Alexander, J., & Lee, S. (2006). Does governance matter? Board
configuration and performance in not-for-profit hospitals.
The Milbank Quarterly, 84, 733–758.
https://doi.org/10.1111/milq.2006.84.issue-4

Alexander, J., Lee, S., Wang, V., & Margolin, F. (2009). Changes
in the monitoring and oversight practices of not-for-profit
hospital governing boards 1989–2005: Evidence from
three national surveys. Medical Care Research Review, 66,181–196. https://doi.org/10.1177/1077558708326527

Anderson, D., Melanson, S., & Maly, J. (2007). The evolution of
corporate governance: Power redistribution brings boards
to life. Corporate Governance, 15, 780–797.
https://doi.org/10.1111/corg.2007.15.issue-5

Bammens, Y., Voordeckers, W., & Van Gils, A. (2011). Boards of
directors in family businesses: A literature review and
research agenda. International Journal of Management
Reviews, 13, 134–152.

https://doi.org/10.1111/j.1468-2370.2010.00289.x
Barney, J. (1991). Firm resources and sustained competitive
advantage. Journal of Management, 17, 99–120.
https://doi.org/10.1177/014920639101700108

Barrett, D., & Windham, S. (1984). Hospital boards and
adaptability to competitive environments. Healthcare
Management Review, 9, 11–20.

Bennedsen, M., Kongsted, H., & Nielsen, K. (2008). The causal
effect of board size in the performance of small and
medium-sized firms. Journal of Banking & Finance, 32,
1098–1109. https://doi.org/10.1016/j.jbankfin.2007.09.016

Berle, A., & Means, G. (1932). The modern corporation and
private property. New Brunswick, NJ: Transaction
Publishers.

Blair, M. (1995). Ownership and control: Rethinking corporate
governance for the twenty first century. Washington, DC:
Brookings.

Campbell, D., & Russo, J. (1999). Social experimentation.
Thousand Oaks, CA: Sage.

Chambers, N., Harvey, G., Mannion, R., Bond, J., & Marshall, J.
(2013). Towards a framework for enhancing the
performance of NHS boards: A synthesis of the evidence
about board governance, board effectiveness and board
development. Health Services and Delivery Research, 1(6).
doi:10.3310/hsdr01060

Clarke, T. (1998). The stakeholder corporation: A business
philosophy for the information age. Long Range
Planning, 31, 182–194. https://doi.org/10.1016/
S0024-6301(98)00002-8

Clarkson, M. (1995). A stakeholder framework for analyzing
and evaluating corporate social performance. Academy of
Management Review, 20, 92–117.

Cornforth, C. (2003). The governance of public and non-profit
organisations: What do boards do? London: Routledge.
https://doi.org/10.4324/9780203167571

Dalton, D., Daily, C., Ellstrand, A., & Johnson, J. (1998). Metaanalytic
reviews of board composition, leadership
structure, and financial performance. Strategic
Management Journal, 19, 269–290.
https://doi.org/10.1002/(ISSN)1097-0266

Davis, J., Schoorman, F., & Donaldson, L. (1997). Toward a
Stewardship theory of management. The Academy of
Management Review, 22, 20–47.

Donaldson, L. (1990). The ethereal hand: Organizational
economics and management theory. Academy of
Management Review, 15, 369–381.

Emslie, S., Oliver, C., & Bruce, J. (2006). Getting governance
right at board level: The policy governance approach to
building better National Health Service Boards. Clinician
Management, 14, 69–77.

Endacott, R., Sheaff, R., Jones, R., & Woodward, V. (2013).
Clinical focus and public accountability in English NHS
Trust Board meetings. Journal of Health Service Research
and Policy, 18, 13–20. https://doi.org/10.1258/
jhsrp.2012.011154

Fama, E., & Jensen, M. (1983). Separation of ownership and
control. Journal of Law and Economics, 26, 301–325.
https://doi.org/10.1086/467037

Finkelstein, S., & Mooney, A. (2003). Not the usual suspects:
How to use board process to make boards better.
Academy of Management Executive, 17, 101–113.
https://doi.org/10.5465/AME.2003.10025204

Ford-Eickhoff, K., Plowman, D., & McDaniel, R. (2011). Hospital
boards and hospital strategic focus: The impact of board
involvement in strategic decision-making. Health Care
Management Review, 36, 145–154.
https://doi.org/10.1097/HMR.0b013e3182099f6e

Francis, R. (2010). The mid-staffordshire NHS foundation trust
inquiry. London: Department of Health.

Francis, R. (2013). The mid staffordshire NHS foundation trust
public inquiry. London: Stationery Office.

Garratt, B. (1997). The fish rots from the head. London:
HarperCollins Business.

Greer, A., Hoggett, P., & Maile, S. (2003). Are quasigovernmental
organisations effective and accountable?
In C. Cornforth (Eds.) The governance of public and nonprofit
organisations. What do boards do? (pp. 40–56).
London: Routledge.

Haverland, M., & Yanow, D. (2012). A Hitchhiker’s guide to the
public administration research universe: Surviving
conversations on methodologies and methods. Public
Administration Review, 72, 401–408.
https://doi.org/10.1111/j.1540-6210.2011.02524.x

Hendry, J. (2005). Beyond self-interest: Agency theory and the
board in a satisficing world. British Journal of
Management, 16, S55–S63.

https://doi.org/10.1111/bjom.2005.16.issue-s1
Heracleous, L., & Jacobs, C. (2008). Understanding
organizations through embodied metaphors. Organization
Studies, 29, 45–78. https://doi.
org/10.1177/0170840607086637

Herman, R. (2009). Are public service nonprofit boards meeting
their responsibilities? Public Administration Review, 69,
387–390. https://doi.org/10.1111/puar.2009.69.issue-3

Hillman, A., Withers, M., & Collins, B. (2009). Resource
dependence theory: A review. Journal of Management, 35,
1404–1427.
https://doi.org/10.1177/0149206309343469

Hodgkinson, G., & Sparrow, P. (2002). The competent
organization: A psychological analysis of the strategic
management process. Buckingham: Open University
Press.

Huse, M. (2007). Boards, governance and value creation: The
human side of corporate governance. Cambridge:
Cambridge University Press.
https://doi.org/10.1017/CBO9780511611070

Jagosh, J., Macaulay, A., Pluye, P., Salsberg, J., Bush, P. L.,
Henderson, J., … Seifer, S. D. (2012). Uncovering the
benefits of participatory research: Implications of a realist
review for health research and practice. Milbank Quarterly,
90, 311–346. https://doi.org/10.1111/milq.2012.90.issue-2

Jensen, M., & Meckling, W. (1976). Theory of the firm:
Managerial behavior, agency costs and ownership
structure. Journal of Financial Economics, 3, 305–360.
https://doi.org/10.1016/0304-405X(76)90026-X

Jiang, H., Lockee, C., Bass, K., & Fraser, I. (2009). Board oversight
of quality: Any differences in process of care and
mortality? Journal of Healthcare Management, 54, 15–30.

Kosnik, R. (1987). Greenmail: A study of board performance in
corporate governance. Administrative Science Quarterly,
32, 163–185. https://doi.org/10.2307/2393124

Lee, S., Alexander, J., Wang, V., Margolin, F., & Combes, J.
(2001). An empirical taxonomy of hospital board roles.
Health Services Research, 43, 1223–1243.

Lorsch, J., & Clark, R. (2008). Leading from the boardroom
Harvard Business Review, 86, 104–111.

Lorsch, J., & MacIver, E. (1989). Pawns or potentates: The reality
of America’s corporate boards. Boston, MA: Harvard
Business Press.

Lynall, M., Golden, B., & Hillman, A. (2003). Board composition
from adolescence to maturity: A mult-theoretic view.
Academy of Management Review, 28, 416–431.

Mace, M. (1972). The president and the board of directors.
Harvard Business Review, 50, 37–49.

Mannion, R., Freeman, T., Millar, R., & 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).

McDonagh, K., & Limbdenstock, R. (2006). Hospital governing
boards: A study of their effectiveness in relation to
organisation performance. Journal of Healthcare
Management, 51, 377–391.

McNulty, T., Roberts, J., & Stiles, P. (2003). Creating accountability
within the board: The work of the effective non-executive
director. London: Department of Trade and Industry.

Millar, R., Mannion, R., Freeman, T., & Davies, H. (2013). Hospital
board oversight of quality and patient safety: A narrative
review and synthesis of recent empirical research. Milbank
Quarterly, 91, 731–770.

Nicholson, G., & Kiel, G. (2007). Can directors impact
performance? A case-based test of three theories of
corporate governance. Corporate Governance, 15, 585–608.

Perrow, C. (1986). Complex organisations: A critical essay (3 rd
ed.). New York, NY: McGrawHill.
Pawson, R., & Tilley, N. (1997). Realistic evaluation. London:
Sage.

Perry, T., & Shivdasani, A. (2005). Do boards affect
performance? Evidence from corporate restructuring. The
Journal of Business, 78, 1403–1432.

Pfeffer, J., & Salancik, G. (2003). The external control of
organizations: A resource dependence perspective. CA:
Stanford Business Books.

Public Administration and Constitutional Affairs Committee
(2016). The collapse of Kids Company: Lessons for charity
trustees, professional firms, the Charity Commission, and
Whitehall. London: The Stationery Office.

Pye, A., & Pettigrew, A. (2005). Studying board context, process
and dynamics: Some challenges for the future. British
Journal of Management, 16, S27–S38.
https://doi.org/10.1111/bjom.2005.16.issue-s1

Ramsay, A., & Fulop, N. (2011). Understanding the evidence:
Supporting governance of emerging Clinical Commissioning
Groups. London: National Leadership Council.

Selim, G., Verity, J., & Brewka, E. (2009). Board effectiveness: A
literature review. London: Cass Business School.

Shen, W., & Cannella, A. (2002). Power dynamics within top
management and their impacts on ceo dismissal
followed by inside succession. Academy of Management
Journal, 45, 1195–1206. https://doi.org/10.2307/3069434

Stiles, P., & Taylor, B. (2001). Boards at work: How directors view
their roles and responsibilities. Oxford: Oxford University
Press.

Terjesen, S., Sealy, R., & Singh, V. (2009). Women directors on
corporate boards: A review and research agenda
Corporate Governance: An International Review, 17, 320–
337. https://doi.org/10.1111/corg.2009.17.issue-3
Useem, M. (2006). How well-run boards make decisions.
Harvard Business Review, 84, 130–136.

Veronesi, G., Kirkpatrick, I., & Vallascas, F. (2014). Does clinical
management improve efficiency? Evidence from the
English National Health Service. Public Money and
Management, 34, 35–42.

https://doi.org/10.1080/09540962.2014.865932
Vieito, J., & Khan, W. (2012). Executive compensation and
gender: S&P 1500 listed firms. Journal of Economics and
Finance, 36, 371–399. https://doi.org/10.1007/
s12197-010-9123-1

Wong, G., Greenhalgh, T., Westhorp, G., & Pawson, R. (2014).
Development of methodological guidance, publication
standards and training materials for realist and metanarrative
reviews: The RAMESES project. Health Services
and Delivery Research, 2, 30.

www.seattletimes.com. (2015). Virginia-mason-failed-to-properlyreport-
superbug 2 August 2015. Retrieved April 7, 2016.