title: Interaction between non-executive and executive directors in English National Health Service trust boards: an observational study.
abstract: BACKGROUND
  National Health Service (NHS) trusts, which provide the majority of hospital and community health services to the English NHS, are increasingly adopting a 'public firm' model with a board consisting of executive directors who are trust employees and external non-executives chosen for their experience in a range of areas such as finance, health care and management. In this paper we compare the non-executive directors' roles and interests in, and contributions to, NHS trust boards' governance activities with those of executive directors; and examine non-executive directors' approach to their role in board meetings.
  
  
  METHODS
  Non-participant observations of three successive trust board meetings in eight NHS trusts (primary care trusts, foundation trusts and self-governing (non-foundation) trusts) in England in 2008-9. The observational data were analysed inductively to yield categories of behaviour reflecting the perlocutionary types of intervention which non-executive directors made in trust meetings.
  
  
  RESULTS
  The observational data revealed six main perlocutionary types of questioning tactic used by non-executive directors to executive directors: supportive; lesson-seeking; diagnostic; options assessment; strategy seeking; and requesting further work. Non-executive board members' behaviours in holding the executive team to account at board meetings were variable. Non-executive directors were likely to contribute to finance-related discussions which suggests that they did see financial challenge as a key component of their role.
  
  
  CONCLUSIONS
  The pattern of behaviours was more indicative of an active, strategic approach to governance than of passive monitoring or 'rubber-stamping'. Nevertheless, additional means of maintaining public accountability of NHS trusts may also be required.
authors.affiliation: School of Government, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK. r.sheaff@plymouth.ac.uk.
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.affiliation: School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK. ruth.endacott@plymouth.ac.uk.|School of Nursing & Midwifery, Monash University, Melbourne, Australia. ruth.endacott@plymouth.ac.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Endacott
authors.affiliation: School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK. ray.jones@plymouth.ac.uk.
authors.forename: Ray
authors.initials: R
authors.lastname: Jones
authors.affiliation: School of Nursing & Midwifery, Plymouth University, Portland Villas, Drake Circus, Plymouth, PL4 8AA, UK. vawoodward@btinternet.com.
authors.forename: Val
authors.initials: V
authors.lastname: Woodward
mesh_terms: D000288:Administrative Personnel; D003142:Communication; D004739:England; D005582:Foundations; D006075:Governing Board; D006801:Humans; D007400:Interprofessional Relations; D012941:Social Responsibility; D013222:State Medicine; D035502:Trust