Board dynamics and relational tensions in the English NHS foundation trusts

This study explores interactional dynamics and relational tensions within English NHS Foundation Trust board meetings that are influenced by governance structure and the board composition.

This paper draws upon an ethnonarrative approach to enable the understanding of the nuances of boardroom interactions. Data was collected through participant observation of board of directors' and board of governors' meetings and narrative interviews from directors and governors of two NHS Foundation Trusts. Data was analyzed through thematic narrative analysis to enable the identification and understanding of the patterns and the hidden tensions in boards.

Findings reveal that board interactions are influenced strongly by the nexus of structural, contextual and human elements of governance. Three main findings are highlighted: a lack of clarity of the governors' and chairpersons' roles which create ambiguities within board processes; the large size of the board of governors disrupts meaningful discussions in board meetings; the unacceptability and avoidance of governors' accountability by the directors creates a struggle for supremacy and legitimacy in boards.

Future research can explore both the positive and negative outcomes of board behaviors, which are influenced by the perceived built-in tensions in governance structures. In addition, access to other spaces of governance, such as, subcommittee meetings and private board meetings can further enrich our understanding of board dynamics.

This study attempts to uncover the neglected modes of interactions within boards through a combination of two disparate perspectives: board structures/composition and interactions through an ethnonarrative approach.