Seven questions to ask of an NHS non-executive director

Essentials

Does the non-executive have the right experience, skills and qualities?

2. How good are key relationships-with chairman, other board members, senior staff and relevant outside bodies?

Some experience, skills and qualities can be identified – professional background, relevant experience, ability to operate in the public sector etc. The right skills will also depend on what’s available from the other non-executives.

The qualities identified by Higgs and the NHS (see box) have to be exercised through an ability to work as part of a team and through delicate balances – being challenging yet supportive and independent yet involved. Relationships need to be uninvolved enough to maintain independence, yet not be aloof, uninformed or marginal.

Each of these balances is very difficult to maintain in practice – the relationships with executives in particular. And within the board, the ability to do so as a member of the team is crucial. Adapting the old saying, any non-executive who thinks it’s easy probably doesn’t understand the problem. Balancing is made more subtly complicated because of divergent interests of different stakeholders and the implicit ambiguity, when a non-executive speaks, about whose interests are being represented.

How to measure these?

Ask the opinion of other board members, executive and non-executive, and those with whom there are regular relationships. Judgement rather than box-ticking is required here. This applies not only to intangible qualities but even to skills and experience – either may be fine on paper, but out of date or irrelevant to current circumstances.

This is why the value of the annual performance review lies in the discussion with the chairman. First year contributions will be limited, particularly if the new non-executive does not have a health service background, but after that, the annual performance review needs to cover difficult areas, including underperformance and the implications of bringing conflict into the open. Being over-polite doesn’t help. Does “good colleague” mean “great contributor” or “easy to push around”? And is “lively contributor” really “talks too much”?

Contribution – impact and output

3. Is the non-executive clear about what good performance means?

4. How good is the quality of his/her contribution in and between meetings?

5. What is his/her influence on decisions?

Contribution is the key area for performance. Turning up to meetings and putting in the hours are not enough and are certainly not performance measures.

The four Higgs areas for non-executive attention - strategy, performance, risk and people – will equally apply in an NHS context, though the Department of Health understandably also identifies finance. Working in the public interest and keeping patients and public informed are more specifically public sector related. But not everything can be given top priority, so relative strengths and weaknesses should be taken into account. The agenda will- and should- change over time.

Objectives agreed annually by the chairman and the non-executive are the starting point and should be as specific as possible, while recognising that contributions may take time to become evident. They should be personal - for example someone coming from the private sector may need to adjust to working for a non-profit organisation. They should also recognise that the impact of contributions to decisions may take time – certainly more than a year – to become evident.

The position of those who are explicitly or implicitly representatives of sectional interests need special consideration at a time when objectives are set. The objectives need to reflect the subtleties of the trade-offs between the needs of the interest group and those of the organisation as a whole.

Having the right information is essential to meet the objectives. Non-executives can complain that they don’t know what’s happening, but not if they fail to ask for the appropriate information. Their ability to contribute quickly will be greatly helped by a proper induction process. Being talked at for hours and having a foot of bumph to read is not induction.

How to measure these?

Other board members will again be the main source of information but if there are specific areas of specialisation, such as community relationships or patient-related initiatives – those involved should also be asked.

There are plenty of signals on contribution. They include evidence that a non-executive has done the homework, can put a case, knows enough to talk about more than the basics - people and policy, not just processes - can take a wider view, shows personal judgement and applies technical expertise to current issues. Together these provide credibility, w ithout which the non-executive will not be able to contribute significantly or meet the Higgs requirement to gain the “trust and respect of other board members”.

Lots of questions can be asked about contribution – “How far is x able to look at the big picture?” and “How far does y get to the heart of key issues?” etc. But credibility is the key. Two crunch questions here: when z starts to intervene, do you pay close attention to what’s being said? Ask other non-executives to indicate a score from 1 (switch off) to 10 (listen very closely). You’ll find the results revealing. The second is when they intervene on a matter where you’re not sure you can make a judgement, would you trust theirs?

Sustaining contribution

6. What does the non-executive do to keep himself/herself up to date?

A good non-executive needs to ensure that the quality of contributions can be sustained. This means updating expertise about the health service, the organisation itself and specific technical skills, such as governance, risk and finance. Considering the sheer volume of guidance on each of these areas, this is no mean task. Non-executives have the right to expect that the organisation will signal the importance of information sent out to them.

How to measure this?

It’s clear in board and other discussions when someone is drawing on reserves of expertise without renewing them. The chairman should anticipate this by emphasising the importance of personal development when setting objectives and following up to make sure that what was agreed has been completed. If the organisation doesn’t offer opportunities (that’s not just more mountains of paper to read) the non-executive should take the initiative and ask.

..and finally

7. Knowing when to go

Good performance means not hanging on too long. The temptation for the non-executive and colleagues is to stick with what is familiar. As an ex-non-executive of Monsoon noted: “I was becoming too sympathetic. I knew what the problems were and was finding it difficult to challenge without nagging and carping.” The temptation for the non-executive and colleagues is to stick with what is familiar. This isn’t good for the organisation or the non-executive.

How to measure this?

By honesty in the annual discussion with the chairman, particularly in the run up to contract renewal time. This isn’t about any fixed period. A self test for non-executives? If you keep asking yourself whether it’s time to go, it probably is.

Conclusion

Success is not about hours reading the papers or talking a lot. A good non-executive can raise the quality of the whole board, just as a poor one can drag everyone down. What’s worse, a poor non-executive takes up a place that could be filled by someone of higher quality. Yet performance measurement is often inadequate, through habit, ignorance of best practice and probably a tendency to embarrassment about confrontation.

The annual appraisal process is a crucial opportunity to talk about wider issues of performance as well as filling in the required forms. And it’s the chairman who must ensure that the process has value. If the chairman’s implicit message is “this is a bore but we have to get through it”, the opportunity will be lost. It needs to be clear that the discussion is welcome as an important part of the process. The value of the appraisal will also be increased if it complements board reviews which address the real issues and are followed up.

Everyone has an interest in making sure that the organisation gets the best out of its non-executives. Asking the seven questions can make a huge contribution to making it happen.

Sir Andrew Likierman is professor of management practice at the London Business School. He is a health trust non-executive director and has wide experience on public and private sector boards. This is an extended and updated version of an article which was posted on the Health Service Journal website. alikierman@london.edu

Non-executives

“..should be sound in judgement and have an inquiring mind. They should question intelligently, debate constructively, challenge rigorously and decide dispassionately. And they should listen sensitively to the views of others, inside and outside the board”. Higgs Report p28.

…should have the competencies required…. These include “commitment to patient needs; forward planning capability; ability to challenge constructively; influencing and persuasion skills; team working approach; self motivation; clear and creative thinking.” NHS Appointments Commission website

“… have a crucial role to play in representing the public interest in the conduct of the Trust’s affairs. They must be people with a high level of ability and experience in the leadership of organisations.” Bristol Royal infirmary inquiry quoted in Department of Health integrated governance handbook p31

Two crunch questions

When a non-executive:

- starts to speak, how much attention do you pay to what’s being said?

- intervenes on a matter where you’re not sure you can make a judgement, would you trust theirs?

From hesitant beginnings, the influence of non-executives in the NHS has steadily grown. Foundation trust status further reinforces their role. So how would non-executives and their colleagues know they were doing a good job? Sir Andrew Likierman, professor of management practice at the London Business School, says there are seven questions which can help individuals, and those with whom they work, think about what success means.

There’s no lack of formal guidance on what’s required, with lists of desirable criteria set out by the NHS Appointments Commission and Department of Health, reinforced by individual appraisal and board performance reviews.

But many of the factors which make the difference between a good and poor individual performance can’t be easily captured by lists of criteria.