This study compares different approaches to corporate governance in NHS organisations during the first phase of the COVID-19 pandemic. Boards have shown they can be highly adaptive and agile, flexing their governance practices to make space for emergency response items and adopting technology to facilitate the continuation of governance business. Governance professionals have been instrumental in advising on and implementing changes whilst facing a high degree of uncertainty and capacity pressures.

Key insights identified from the survey:

1. Boards have adapted their work plans to make space for crisis response while trying to maintain as much focus on BAU as practicable. Good practice emerges when boards take a forward view in the face of significant strategic challenge, reprioritising to establish what can be deferred or dropped and for how long.
2. What organisations deprioritised is of as much interest as what they prioritised. This warrants further investigation to understand the degree of consistency in terms of what is deemed ‘essential’ and to ascertain whether values-driven policies such as patient and public involvement and quality related items may be viewed as ‘desirable’ when agendas are under pressure.
3. The study identified the potential for instability and for power to shift during times of crisis. The majority of boards were perceived to be relatively balanced in terms of Executive and Non-Executive participation, however, tensions and shifts in dominance were witnessed in some organisations. There is a challenge for boards to ensure they operate as expected of the unitary board model where all members are required to contribute equally to adhere to good governance principles.
4. Non-Executive directors (NEDs), in some organisations, were said to be disconnected due to their physical remoteness. This potentially diminishes the purpose and impact of the unitary board, and particularly its role as the conscience of the organisation.
5. In terms of guidance available during the emergency response, governance professionals placed strong reliance and value on informal networks and peer support, and the study found that centralised guidance could have been better.
6. Boards have continued to use existing assurance frameworks and reporting mechanisms, adapting them to incorporate COVID-specific risks. Consideration of the pandemic as a cross-cutting challenge across all strategic objectives offers a robust means of assessing the altered risk environment and determining what additional assurances the board should seek.
7. Boards have adapted quickly and adopted virtual platforms in order to hold board meetings. Consideration should be given to mitigating some of the disbenefits reported with regard to potential erosion of debate and scrutiny.
8. Changes prompted by the pandemic facilitated a more agile and efficient way of working that is highly desirable to be continued. There was a sense that this is an opportune time to exploit the wave of change to explore different options for future governance arrangements and system-wide governance models.


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>> An exploratory empirical study of changes in corporate governance practices in localNHS organisations during the first phase of the COVID-19 pandemic.

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