The medical facility was among the smallest in England and was thought to be too small to be viable in the long-term. A merger was being considered but there was considerable uncertainty that this was the best way to grow.

It was also the case that the Chair and some Non-executive Directors were due to retire; inevitably this was an additional pressure for the Board.

Kennedy was commissioned to undertake a Board Evaluation with the focus on the Board capability. The review was considered complementary to the separate assessment of financial viability. Find out more about our Governance & Oversight service here.

How we gathered data

The assignment required us to gather data from a range of sources. We did this through:

    • Discussion with the Chair and CEO to understand the background and purpose of the assignment
    • Desk research to review minutes of key meetings
    • Access to key documents eg the current strategy and operations plan, and previous evaluation reports
    • Access to any documentation on current governance arrangements
    • Observation of the formal Board and Executive meetings, the sub-committee meetings and any other governance events, together with access to the papers submitted
    • Confidential discussions with each member of the Board and Executive
    • A questionnaire to consider the control procedures; the strategic aims of the business; the entrepreneurial leadership of the top team; and the focus of internal and external communications and relationships
    • Profiling individual Board and Executive members to understand their impact on decision-making
    • Group discussions with direct reports to the Board and Executive to assess the impact of decisions
    • Interviews with the primary external stakeholders where appropriate

What differentiated this review from that of competitors was the particular focus on the dynamics and decision-making of the top team.

Some key findings and actions

The review took three months from being commissioned to presenting the report and recommendations to the Board.

Our findings showed that in many respects the Governance & Oversight arrangements complied with good practice, but action was required in a number of areas.

Unnecessary overlap and duplication

The formal structures of the Board and sub-committees duplicated effort. Discussions were held in a number of overlapping forums. The supporting paperwork was frequently adjusted to the needs of each, although there was no significant difference in the messages being conveyed.

Action was taken to better define the role of each forum, and the paperwork streamlined so that the discussions could be supported by a single core document.

Discussions were fragmented

Often aspects of a concern were discussed under different headings in a meeting. This fragmentation made it difficult to take a holistic view and could lead to inconsistent messages around the decisions taken.

This process was adjusted to ensure that each subject was considered in full under a single agenda item, and with the benefit of all Board members involved in the decisions reached.

The focus was too operational

The focus of the Board meeting was heavily biased towards operational issues and monitoring performance. It was essential to have a better balance of the operational and strategic concerns to ensure that the big strategic decisions received the attention needed.

On-going monitoring of performance was delegated to a sub-committee. The Board was kept informed of areas of concern and could feel confident that oversight of performance was receiving the right level of scrutiny.

Integrating a new Chief Technical Officer

At the time of the Review a major project was underway to streamline the IT system so that all parts of the medical facility could access and use a single system. The intent was that there would be a single data entry system that could be accessed and used for all the myriad purposes required by the clinical and administrative staff.

Traditionally the Head of Department had reported to the Operations Director. The decision was taken to have the new CTO report to the CEO while the new system was being designed and implemented.

Changes in responsibility

To achieve a better alignment of roles and responsibilities with the individual Executive members several changes were recommended. These were accepted and implemented.

Merger not pursued

The Board decided the proposed merger was not the best way forward and instead formed a hospital grouping. This allowed the medical facility to achieve financial stability and to deploy its staff more effectively to optimise services.

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