Developing Effective Boards
NHS Board Development Programme
Our approach
The way people work together is the foundation of our work with NHS Boards. Systems and processes of governance are important of course, but the best processes in the world will not ensure great Board performance. It’s the Board’s behaviours and values that really make the difference. Levels of trust, the ability to challenge appropriately and to make and keep to sounds decisions, the balance of individual and corporate responsibility are all elements that make or break great Boards.
We have developed a programme designed to take NHS Boards from compliance to performance. It is based on the Board Competency Framework and a brief description is given here.
The Development Programme
Our Board Development Programme is divided into two stages:
- Diagnostic
- Development
Both stages use our new competency framework to provide Boards with a clear direction.
NHS Board Development roadmap (click to enlarge)

We bring together a team of individuals with complementary skills and experiences who have worked with NHS Boards for over 10 years.
The Board Competency Framework
The Framework is based on a set of competencies for NHS Boards aspiring to be high performing Boards driving a successful organisation.
Developed specifically for NHS Boards, from a range of NHS and industry references a key reference point for the Framework is the work of Bob Garratt. Garratt has written extensively on Board performance –‘The Fish Rots from the Head’, ‘Thin on Top’. His work is held in high regard in both the private and public sector. Monitor use his “Learning Board Model” in their documentation.
The competency set is a foundation for:
- Setting the standard of expectations of high performance; setting the tone at the top of the organisation
- Assessing the Board’s performance against those standards on a regular basis
- Benchmarking current and future performance to map improvement
The competence set has a number of applications:
- Personal development
- Board development
- Leadership profiling for recruitment and selection
- Performance management
The Competency Set focuses on six key areas:
- Strategic leadership
- Governance
- Strategic decision making
- Maximising Board performance
- Constructive challenge
- Demonstrating trust
The Framework has been used with high performing Boards, keen to develop further, with aspirant Foundation Trusts and is applicable to both commissioning and provider organisations.
Using the Model
We have designed a range of Board assessment tools using the competency framework to provide a fully rounded picture of current performance.
The tools include:
- Workshop sessions
- Web surveys
- Individual 360° feedback tools



