Hospital Boards and Health Care Quality Project

Health-care scandals, such as the most recent at Mid Staffordshire NHS Foundation Trust, have demonstrated that uncaring practices can flourish in hospitals when the organisational context goes wrong.

When this happens, patients not only have unpleasant experiences during care but can be hurt or even die as a consequence. Hospital boards have ultimate responsibility for safeguarding the care provided in their organisation, yet recent high-profile reports on serious failings in the quality of hospital care in the NHS have raised concerns over the ability of boards to discharge their duties effectively in this area.

Professor Russell Mannion, Dr Ross Millar and colleagues have recently completed a HSDR funded study which sought to better understand the processes associated with the effective board governance of safe care. Based on a review of the available evidence and research in hospitals we examine in detail what hospital boards actually do in relation to safeguarding care in their organisation; for example, how much time they spend discussing patient safety issues, the types of information boards use to assess the quality of care in their organisation, what training and skills board members have in relation to patient safety and how factors, such as external financial incentives, influence what boards do in relation to patient safety.

The study comprised three distinct but interlocking strands:
(1) a narrative systematic review in order to describe, interpret and synthesise key findings and debates concerning board oversight of patient safety;
(2) in-depth mixed-methods case studies in four organisations to assess the impact of hospital board governance and external incentives on patient safety processes and outcomes; and
(3) two national surveys exploring board management in NHS acute and specialist hospital trusts in England, and relating board characteristics to whole-organisation outcomes.The study  found that what boards do and focus on is related to how their hospital reacts to and deals with patient safety issues. In particular, we found a link between self-assessed competencies of boards and whether or not its staff felt able to openly report patient safety-related problems and incidents.

Full HSDR project report

Mannion, R., Freeman, T., Millar, R. and 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) [online]. Available at: [Accessed 25 January 2018]

Other related publications 

Freeman, T., Mannion, R., Millar, R., and Davies, H.T.O. (2017) Decentring patient safety governance: Case studies of four English Foundation Trust hospital Boards. In: Bevir, M. and Waring, J. (eds) Decentring health policy: Learning from British experiences in healthcare governance. London: Routledge.

Freeman, T., Millar, R., Mannion, R., and Davies, H. (2016) Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England. In: Allen, D., Braithwaite, J., Sandall, J., Waring, J. (eds) The sociology of healthcare safety and quality. Chichester: John Wiley & Sons. pp. 52-68.

Freeman, T., Millar, R., Mannion, R. and Davies, H. (2016) Enacting corporate governance of healthcare safety and quality: a dramaturgy of hospital boards in England. Sociology of Health and Illness, 38: 233–251. doi: 10.1111/1467-9566.12309

Mannion, R., Davies, H.T.O., Jacobs, R., Kasteridis, P., Millar, R. and Freeman, T. (2017) Do hospital boards matter for better, safer, patient care? Social Science and Medicine, 177: 278-287.

Mannion, R. and Millar, R. (2016) Getting hospital boards on board with patient safety. HSMC Viewpoint, published online on 20th April 2016.

Mannion, R. and Davies, H.T.O. (2016) Whistleblowing in the wind towards a socially situated research agenda: a response to recent commentaries. International Journal of Health Policy and Management, 5(6): 395-396 doi: 10.15171/ijhpm.2016.34

Mannion, R. and Davies, H.T.O. (2015) Cultures of silence and cultures of voice: the role of whistleblowing in healthcare organisations. International Journal of Health Policy and Management, 4(8): 503-505. DOI:10.15171/ijhpm.2015.120

Mannion, R., Davies, H., Millar, R., Freeman, T., Jacobs, R. and Kasteridis, P. (2015) Overseeing oversight: governance of quality and safety by hospital boards in the English NHS. Journal of Health Services Research and Policy, 20 (15): 9-16.

Millar, R., Freeman, T. and Mannion, R. (2015) Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence. BMC Health Services Research, 15: 196. DOI 10.1186/s12913-015-0771-x

Millar, R., Mannion, R., Freeman, T. and Davies, H. (2013) Hospital board oversight of quality and patient safety: A narrative review and synthesis of recent empirical research. Milbank Quarterly, 91 (4): 738-770.