Mannion Russell, Davies Huw, Freeman Tim, Millar Ross, Jacobs Rowena, Kasteridis Panos
Professor, Health Services Management Centre, University of Birmingham, UK
Professor, School of Management, University of St Andrews, UK.
J Health Serv Res Policy. 2015 Jan;20(1 Suppl):9-16. doi: 10.1177/1355819614558471.
To contribute towards an understanding of hospital board composition and to explore board oversight of patient safety and health care quality in the English NHS.
We reviewed the theory related to hospital board governance and undertook two national surveys about board management in NHS acute and specialist hospital trusts in England. The first survey was issued to 150 trusts in 2011/2012 and was completed online via a dedicated web tool. A total 145 replies were received (97% response rate). The second online survey was undertaken in 2012/2013 and targeted individual board members, using a previously validated standard instrument on board members' attitudes and competencies (the Board Self-Assessment Questionnaire). A total of 334 responses were received from 165 executive and 169 non-executive board members, providing at least one response from 95 of the 144 NHS trusts then in existence (66% response rate).
Over 90% of the English NHS trust boards had 10-15 members. We found no significant difference in board size between trusts of different types (e.g. Foundation Trusts versus non-Foundation Trusts and Teaching Hospital Trusts versus non-Teaching Hospital Trusts). Clinical representation on boards was limited: around 62% had three or fewer members with clinical backgrounds. For about two-thirds of the trusts (63%), board members with a clinical background comprised less than 30% of the members. Boards were using a wide range and mix of quantitative performance metrics and soft intelligence (e.g. walk-arounds, patient stories) to monitor their organisations with regard to patient safety. The Board Self-Assessment Questionnaire data showed generally high or very high levels of agreement with desirable statements of practice in each of its six dimensions. Aggregate levels of agreement within each dimension ranged from 73% (for the dimension addressing interpersonal issues) to 85% (on the political).
English NHS boards largely hold a wide range of attitudes and behaviours that might be expected to benefit patient safety and quality. However, there is significant scope for improvement as regards formal training for board members on quality and safety, routine morbidity reporting at boards and attention to the interpersonal dynamics within boards. Directors with clinical backgrounds remain a minority on most boards despite policies to increase their representation. A better understanding of board composition, actions and attitudes should help refine policy recommendations around boards.
促进对医院董事会构成的理解，并探讨英国国民医疗服务体系（NHS）中董事会对患者安全和医疗质量的监督。
我们回顾了与医院董事会治理相关的理论，并针对英格兰NHS急症和专科医院信托机构的董事会管理开展了两项全国性调查。第一次调查于2011/2012年向150个信托机构发放，通过专用网络工具在线完成。共收到145份回复（回复率97%）。第二次在线调查于2012/2013年进行，针对董事会成员个人，使用一份先前验证过的关于董事会成员态度和能力的标准工具（董事会自我评估问卷）。共收到来自165名执行董事和169名非执行董事的334份回复，当时存在的144个NHS信托机构中有95个至少提供了一份回复（回复率66%）。
超过90%的英国NHS信托机构董事会有10至15名成员。我们发现不同类型的信托机构（如基金会信托机构与非基金会信托机构、教学医院信托机构与非教学医院信托机构）在董事会规模上没有显著差异。董事会中的临床代表有限：约62%的董事会有三名或更少具有临床背景的成员。约三分之二的信托机构（63%）中，具有临床背景的董事会成员占成员总数不到30%。董事会正在使用广泛多样的定量绩效指标和软信息（如巡查、患者故事）来监督其组织的患者安全情况。董事会自我评估问卷数据显示，在其六个维度中，对各项理想实践陈述的总体认同度普遍较高或非常高。每个维度内的总体认同度从73%（针对人际关系问题维度）到85%（关于政治维度）不等。
英国NHS董事会在很大程度上持有一系列可能有利于患者安全和质量的态度和行为。然而，在为董事会成员提供关于质量和安全的正式培训、董事会的常规发病率报告以及对董事会内部人际关系动态的关注方面，仍有很大的改进空间。尽管有增加具有临床背景董事代表性的政策，但在大多数董事会中，具有临床背景的董事仍然是少数。更好地理解董事会的构成、行动和态度应有助于完善围绕董事会的政策建议。
