A selection of example questions boards should ask themselves in relation to their role in improvement. These aim to help guide personal reflection, conversations between board members and in quality committees, with staff and with partners locally.

This list does not cover everything you may wish to or need to ask, but is intended to help provide a starting point and overview of important aspects to consider.


Leadership and governance

  • Do we have sufficient quality expertise on our board to ensure adequate scrutiny and challenge around quality issues? *
  • Have we provided NEDs with sufficient induction and developmental support to ensure that they are comfortable contributing to discussions around quality issues, and do they understand how change happens in a complex adaptive system like healthcare?
  • Have we considered how our leadership styles may need to adapt to support improvement, for instance, from being a ‘problem solver’ to a ‘problem framer’, and adopting a coaching mentality?
  • How do our board and committee reports support discussion and debate around quality issues? *
  • Do the board and committees /consider the breadth and quality of the data used for improvement, and have the skills to interrogate and analyse it, and ensure it is used meaningfully in decision-making and acted upon?
  • It can take several years to plan and implement a trust wide improvement programme. How prepared and willing are you to maintain support for a programme of this length?
  • Do we have a clear understanding of the place of quality improvement in the way we work as a board and organisation, and a plan to use it?
  • Do we consider performance, improvement and organisational development together at board level, articulating how they work towards our shared goals for improvement?
  • Are we considering how the board can create a better balance between improvement and assurance moving forward, and enable innovation?
  • Are we framing the narrative of improvement around the positive impact for patients and in line with what is most meaningful for staff, rather than articulating in terms of financial objectives?
  • Are we considering how we might commit some resources for improvement based on trust, to allow people to take action and test ideas?


Improvement cultures, behaviours and skills


  • Has the right environment been created within our organisation to support quality improvement? How do we know?*
  • Has an audit of existing improvement knowledge and skills within the organisation, alongside current and previous improvement interventions, been undertaken to identify skills gaps, and identify good practice and knowledge on which to build, as part of the planning process for an organisation-wide programme?
  • Are we able to articulate and demonstrate how the organisation’s improvement approach aligns with the values and behaviours expected of all?
  • Have we introduced a people and culture committee, or similar forum, to consider cultural and organisational development issues?*
  • Is there training in improvement principles and methodology for the board and staff, along with on-going access to expertise, and protected time and resources to devote to quality improvement and quality assurance activities?
  • To ensure a strong link between training and practice, following training, do people have the opportunity and support to put those news skills into practice immediately?
  • How are we ensuring that quality improvement and quality assurance activities are not siloed within the remits of certain individuals? *
  • Do we create regular formal and informal opportunities for staff to have open, non-hierarchical and mutually respectful conversations about care quality and how to improve it, across a mix of roles, teams, departments and specialties?
  • Do we show visible engagement with our organisation’s shared purpose when the board visits services?
  • How are improvement and transformation success stories shared across the organisation and up to board level, and are we celebrating successes in a way that motivates staff and informs patients?
  • Is your response when things go wrong consistent with the enabling, learning environment you’re trying to create?
  • In what ways are we considering whether our improvement approach is accessible for all, with simple language that moves away from jargon and helps people engage?
  • Have we considered how we will engage effectively with our staff and the public
    in a post-pandemic world? Has this considered the needs of all the populations that
    we serve?*


Beyond the boundaries of your organisation


  • How are we avoiding operational silos and creating a shared vision for improvement between partners, staff and patients?
  • Do we have a high level of quality expertise amongst the strategic leadership of collaborative partnerships, to best guide systematic improvement across boundaries?
  • How will collaborative work help in creating an open culture and learning system that enables improvement, with a shared understanding of objectives, needs and issues?
  • Is there an understanding of the Quality Management System (QMS) approach (a proven model for improvement, based on three functions: quality planning; quality control; quality improvement)?
  • How is improvement embedded into your shared governance model, how will that be developed in partnership and is there clarity around accountabilities?
  • In what ways are we drawing on a diverse set of experiences, knowledge and perspectives for improvement across boundaries?
  • Quality improvement can provide a common and systematic way in which to solve problems, therefore how will we reflect on the differences and similarities in our existing approaches, and how will we progress together towards a unified one?
  • How will we come together around a common way of speaking about improvement and create a shared understanding of the principles that underpin it?
  • What are the skill levels in improvement across the set of partners’ workforce, and what support is in place to increase or level this?
  • How will we assess what work of lower value could be removed or deprioritised to make way for new improvement work?


* Questions from What every board member needs to know about improvement
and quality assurance, a report from the Good Governance Institute and Perfect Ward,
September 2021.