Trust boards led by chiefs who are not too autocratic and who encourage contributions from non-executives and clinicians perform better in annual health checks, research has revealed.

A three year study found boards with influential non- executive directors and senior clinicians are likely to have high “use of resources” scores, while those dominated by chief executives are disproportionately likely to perform poorly.

Boards where non-executive directors wielded the most influence were disproportionately represented among PCTs scoring good and excellent

It concludes: “It was possible to show [that] trust board governance can make a positive difference.”

It follows an HSJ analysis last week that showed links between increases in manager numbers and quality of service ratings.

The research by academics from Cranfield University, Bath University, University College London Hospitals Foundation Trust and the Open University was based on a survey of all primary care trust and provider trust board directors, as well as in-depth case studies.

Among PCTs, it found all boards with the highest and lowest levels of dominance by chief executives were rated weak in the use of resources part of the 2007-08 annual health check.

The report says: “The results may indicate that either the absence of a clear steer or its excessive deployment is related to poorer organisational performance.”

Boards where non-executive directors wielded the most influence were disproportionately represented among PCTs scoring good and excellent.

Nearly all - 91 per cent - of PCTs with the lowest levels of clinical input were either fair or weak, while all of those rated excellent were influenced “highly” by clinicians.

Clinical directors’ contributions had little bearing on quality of service scores, which the report says may reflect “broader clinical influence in the operations of the trust”.

Acute and mental health trusts followed similar patterns to PCTs, although acute trust boards were particularly likely to have “moderate” to “high” levels of chief executive control.

Among acute trust boards with the lowest levels of clinical influence, 60 per cent were scored weak. But 44 per cent of those with a “very high” clinical influence were rated excellent.

The study The Intended and Unintended Outcomes of New Governance Arrangements within the NHS also found that strategic health authority chief executives regarded themselves as “powerful conduits of central thinking and requirements”, while their board members felt lacking in power. They felt unable to influence foundation trusts and saw themselves as “bypassed” when the Department of Health or NHS put new requirements on PCTs.

The study demonstrated clinical outcome measures were linked to good governance but “less robustly so” than finance ratings.