With Lord Darzi's review of the NHS casting an uncertain light on the role of boards, some members might be forgiven for becoming tetchy, mistrustful, grumbling souls who always seem to be on the defensive

In apparently high-performing organisations and in more troubled ones, we are increasingly coming across a phenomenon that could arguably be termed the "grumpy board".

This can be characterised by tetchy behaviour at formal meetings, grumblings via email, defensive reactions from executive directors and a general climate of mistrust between the various constituencies that make up the board. In some cases, erstwhile good relationships between people who know each other well appear to have deteriorated, and on other occasions it is a turnover of members that has contributed to this new climate.

Is this a familiar picture to Board Talk readers? What might be the reasons for this and what if anything can or should be done about it?

Private sector model

The current unitary structure for English NHS boards has largely been in place since 1990. This structure is based on the private sector model, with a relatively small number (11-16) of executive and non-executive board members, led by a non-executive chair, together having corporate responsibility for the direction and control of local NHS organisations, including strategic development, service quality and financial balance.

Despite continuity in the overall concept of board structure, there have been a number of fundamental developments and re-organisations in the NHS since that time that have affected all boards. For example, to implement Darzi's next stage review there is a need for whole system management and alignment, as argued by David Nicholson recently in HSJ.

Perhaps it is time to rethink the basic structure. Does the board, as currently constituted, still serve its purpose?

There have been subtle changes in the description of the role of non-executive directors. The "steward, ambassador, guardian" descriptor was in vogue from the late 1990s, with "experience" tagged on belatedly to change the unfortunate SAG acronym to a rather more stately and respectful SAGE. The education sector added the term "critical friend" to the mix, and the influence of the Higgs report in 2003 on non-executive directors in the private sector brought more edge and challenge to the role.

Reality check

The foundation trust application process has provided a reality check for many boards about the quality of their work in ensuring clarity of strategic direction and robustness of financial control. A current (August 2008) invitation to tender issued by Monitor and the NHS Institute for a non-executive director development programme for those in current and aspiring FTs suggests that "emotional resilience, robust questioning personalities and demonstrable legitimacy" will be key skills of the most effective non-executive directors.

All this adds up to the likelihood of less comfortable board meetings, although not necessarily less effective. These changes may have crept up relatively unnoticed and therefore unacknowledged by the chief executive and executive director constituency, who will need to be prepared for and to come to terms with these newer non-executive director qualities.

Fit for purpose

There may be some conflicting views about the essential purpose of the board among its members. In his book The Governance of Public and Non-Profit Organisations, Chris Cornforth describes six board models and the different roles and behaviours that flow from these. At one end, in the compliance model, the board members control and supervise management decisions, and at the other end, in the rubber stamp model, board meetings are largely symbolic and tend to ratify decisions taken by management.

In between, there is a supporters' club model, where the focus is on the improvement of external stakeholder relations; a political model, in which a democratic perspective holds sway, with different members' interests represented; a co-option model focused on boundary spanning; and a partnership model, where, as experts, the executives and non-executives share interests and work closely together.

Uncreative conflict may occur when people hold different beliefs about their board and it is worth exploring individual perceptions honestly to understand these differences.

Although a review of the composition of boards is timely, there is probably little point in embarking on a quest for the ideal structure. It may, however, be helpful to reflect on these issues with the aim of creating thoughtful rather than grumpy boards.