At the 2008 chairs' conference held in January, health secretary Alan Johnson ended his keynote address by expressing his 'enormous gratitude' for the important work chairs do for the NHS.

There is nothing unusual about a politician playing to his audience, you might think, but when was the last time you actually heard anyone in politics or the media say a good word about the leadership of the NHS? In our blame culture, it is all too easy to point the finger. We never hear about the success stories or the many talented people who give their time to the governance of the NHS.

But when things do go wrong, we are reminded of just how important the role of chairs and non-executives in the NHS is. Their role is to challenge the executive and hold them to account. Done properly, this can make a real difference to how individual trusts and the NHS as a whole are run.

Big impact

Just how big a difference they can make was superbly illustrated by another speaker at the chairs' conference: Maureen Bisognano, chief operating officer of the Institute for Heathcare Improvement in the US. The institute is an acknowledged international leader in patient safety and Ms Bisognano spoke about her experience of launching campaigns to reduce preventable deaths and incidents of medical harm.

When it became apparent that more people in the US were dying each year from medical injuries than from traffic accidents or breast cancer, the institute asked hospitals to sign up to making just six evidence-based changes to their systems.

Those voluntary changes have saved an estimated 122,000 lives and the institute is now in the second phase of its campaign. The Five Million Lives campaign is a two-year voluntary initiative to protect patients from five million incidents of medical harm.

Getting boards on board

Hospitals are being asked to adopt six further changes, one of which is to "get boards on board". The first phase of the campaign showed a clear correlation between improvements at a hospital and the involvement of its board. The more involved boards became and the more hard questions they asked, the better the hospital performed.

One of the biggest stumbling blocks identified by the institute is the fact that boards often do not understand the medical information given to them because of the technical way in which it is presented.

A key learning point from the US was that board members need to be visible in their hospitals, sit in waiting rooms, talk to patients and staff or spend a day shadowing a doctor or nurse.

Most powerful of all was the practice of telling the story behind the numbers on graphs and charts and bringing an individual patient's experience to the board - literally, in some instances. When patients came in to talk to boards about what had gone wrong with their care, board members very quickly began to ask the right questions of clinicians and managers.

Opportunity for improvement

The US experience demonstrates that when boards take an active role in developing their own learning, the result is a dramatic improvement in patient care.

This July, the NHS Institute for Innovation and Improvement, the National Patient Safety Agency and the Health Foundation are launching the National Patient Safety Campaign. If we are to achieve the same success as the US, then the leadership and commitment of chairs and non-executives will be crucial. And perhaps finally the difference that boards make to the success of the NHS will be recognised and celebrated.

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