title: Hospital board oversight of quality and safety: a stakeholder analysis exploring the role of trust and intelligence.
abstract: BACKGROUND
  Hospital boards, those executive members charged with developing appropriate organisational strategies and cultures, have an important role to play in safeguarding the care provided by their organisation. However, recent concerns have been raised over boards' ability to enact their duty to ensure the quality and safety of care. This paper offers critical reflection on the relationship between hospital board oversight and patient safety. In doing so it highlights new perspectives and suggestions for developing this area of study.
  
  
  METHODS
  The article draws on 10 interviews with key informants and policy actors who form part of the 'issue network' interested in the promotion of patient safety in the English National Health Service.
  
  
  RESULTS
  The interviews surfaced a series of narratives regarding hospital board oversight of patient safety. These elaborated on the role of trust and intelligence in highlighting the potential dangers and limitations of approaches to hospital board oversight which have been narrowly focused on a risk-based view of organisational performance. In response, a need to engage with the development of trust based organisational relationships is identified, in which effective board oversight is built on 'trust' characterised by styles of leadership and behaviours that are attentive to the needs and concerns of both staff and patients. Effective board oversight also requires the gathering and triangulating of 'intelligence' generated from both national and local information sources.
  
  
  CONCLUSIONS
  We call for a re-imagination of hospital board oversight in the light of these different perspectives and articulate an emerging research agenda in this area.
authors.affiliation: Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, B15 2RT, Birmingham, UK. r.millar@bham.ac.uk.
authors.forename: Ross
authors.initials: R
authors.lastname: Millar
authors.affiliation: Department of Leadership, Work and Organisation, Middlesex University Business School, 131 Williams Building, The Burroughs, Hendon, London, NW4 4BT, UK. t.freeman@mdx.ac.uk.
authors.forename: Tim
authors.initials: T
authors.lastname: Freeman
authors.affiliation: Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, B15 2RT, Birmingham, UK. r.mannion@bham.ac.uk.
authors.forename: Russell
authors.initials: R
authors.lastname: Mannion
mesh_terms: D004739:England; D006075:Governing Board; D006739:Hospital Administration; D006801:Humans; D007360:Intelligence; D007407:Interviews as Topic; D007857:Leadership; D061214:Patient Safety / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013222:State Medicine; D035502:Trust