Chapter 5: Information — What the Board Sees Shapes What the Board Does
What Good Looks Like — a board-level guide to governance done well
A board can only govern what it can see. Every judgement it makes about risk, quality or performance rests on the information put in front of it, and almost all of that information arrives through management. So the board pack isn't admin. It's the main way the board finds out what's actually going on.
Chapter 4 looked at the chair and CEO relationship, and the information route that runs between them. This chapter looks at what travels along that route, and how it changes on the way.
The pack that reassures
Most board packs aren't dishonest. They're written by busy people who want the board to feel the organisation is in good hands, and who know the board's time is short. So the pack gets longer, the language gets smoother, and the problems arrive with an action plan already attached.
The result is a familiar kind of document. Two hundred pages, a dashboard with almost everything green, and a covering report that says the amber items are "being actively managed". Directors read it, ask a few questions and move on. Everyone leaves feeling assured. Nobody has actually been told anything new.
How filtering happens
Management filtering is rarely a decision. It happens in small, reasonable steps. A ward manager summarises for the service lead. The service lead summarises for the director. The director summarises for the board. At each stage the detail that seems least important drops out, and the framing gets a little more confident. By the time a concern reaches the boardroom it has been averaged, contextualised and explained.
The usual signs are easy to spot once you look for them. Red ratings that turn amber without anything changing. Trend lines that start conveniently recently. Averages that hide the one service that's struggling. Incidents reported as numbers rather than as what happened to someone. A complaints summary with no complaints in it.
Informed or reassured?
This is the distinction that matters. Reassurance tells the board that things are fine. Information lets the board judge for itself whether things are fine.
A reassuring paper says "mandatory training compliance is 91%, above target". An informing paper says the same, then adds that the overnight team at one site is at 64%, and that's where two of this quarter's three medication incidents happened. The first lets the board relax. The second gives it something to decide.
Good boards learn to ask for the second kind, and to be suspicious of any pack that never makes them uncomfortable. If nothing in the papers has surprised the board for a year, the likeliest explanation isn't that nothing surprising has happened.
What it looks like when it fails
The public inquiry into Mid Staffordshire NHS Foundation Trust, published in February 2013, is still the clearest example in UK healthcare. In his letter to the Secretary of State, Robert Francis QC described "a serious failure on the part of a provider Trust Board. It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust's attention." He put that failure down in part to "allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care."
The warning signs were there, in mortality figures, complaints and concerns raised by staff. The board saw finance and targets in detail and saw patient experience as reassurance. It governed the information it was given, and the information it was given wasn't the information it needed.
Where to start
None of this needs a new reporting system. It needs a board that decides what it wants to know, and a pack built to tell it.
Put a one-page front sheet on every paper. What is this, what does the board need to decide or know, and what's the honest assessment of the level of assurance? "Limited" is a perfectly good answer, and a far more useful one than silence.
Ask for the exceptions, not the averages. Organisation-wide figures are fine as context. The board also needs to see the outliers: the site, the team, the shift that's furthest from where it should be.
Hear from people, not just numbers. A patient story, a complaint read in full, a staff member's account of an incident. These are the things that filtering removes first, and the things that most often change a board's mind.
Go and look. Board visits to services, unannounced where possible, are how directors test whether the pack matches reality. If what you see doesn't match what you read, that tells you something important about the pack.
Once a year, ask what the board wasn't told. Look back at the year's incidents, complaints and inspection findings. How many did issues or problems did the board first hear about through its own papers, and how many from somewhere else?
The second number is the one to work on.
