Publication - Advice and guidance

Being Effective - What NHS Non-Executive Directors Need to Know

Published: 4 Nov 2015
Part of:
Health and social care

Resource booklet for NHSScotland Board Members, with an interest in governance.

36 page PDF

323.8 kB

36 page PDF

323.8 kB

Being Effective - What NHS Non-Executive Directors Need to Know
Shaping a Healthy Community

36 page PDF

323.8 kB

Shaping a Healthy Community

The quality of care patients and service users experience is affected by leaders and managers at all levels of organisations. Effective leaders and managers impact on how organisations perform, how staff feel about their work and their motivation to deliver high-quality care, and how services are developed, delivered and improved. Delivering high-quality services depends on an organisational culture and values that puts patients and service users first and encourages and celebrates innovation, improvement and learning. Non-Executive Directors have a key role in promoting and nurturing such a culture and values.

Governance and culture

A healthy organisational culture is not about what we do, but about how we do it. By developing and sustaining a healthy organisational culture, NHS Boards will create the conditions for high-quality health and care services. Considerable work has been carried out in recent years to develop values and drive behaviours that support a healthy culture.

Good governance flows from a shared ethos or culture, as well as from systems and structures. Non-Executive Directors play a lead role in establishing, modelling and promoting values and standards of conduct for the organisation and its staff.

NHS Boards are responsible for ensuring that their organisation meets the statutory duties in relation to participation and equalities and for promoting good practice by providing leadership as well as challenge.

The actions of NHS Boards are open to public scrutiny. Demonstrating a culture in which participation is encouraged, supported, and valued can be a positive way of developing or reinforcing public confidence in the NHS Boards’ staff and services.

Non-Executive Directors are expected to:

  • actively support and promote a healthy culture for the organisation and reflect this in their own behaviour; and
  • provide visible leadership in developing a health culture so that staff believe they are a safe point of access to the Board for raising concerns.

Knowledge and skills

In practice this means:

  • promoting a positive culture which includes upholding and promoting NHS values as set out in the NHS Board Code of Positive Behaviour;
  • be an ambassador of the Board representing it honestly and positively, engaging with a wide range of organisations;
  • leading by example, behaviour at Board meetings;
  • being visible to staff and patients; and
  • commitment to openness, transparency and candour.


Enabling concerns to be raised and disclosed freely without fear and for questions to be answered


Allowing true information about performance and outcomes to be shared with staff, patients and public


Ensuring that patients harmed by a healthcare service are informed of the fact that an appropriate remedy is offered, whether or not a complaint has been made or a question asked about it

Tips for new Non-Executive Directors to develop practical skills:

  • These skills will develop with experience. Get out and about as much as possible; speak to other Board members, staff, patients and members of the public.

What Non-Executive Directors can do to help shape culture within the Board and organisation:

  • ensure that Board business is conducted in an open, transparent manner;
  • think about whether Board members encourage constructive debate and discussion;
  • ensure that the Board actively publishes information;
  • make sure you know what the Board does to encourage staff to follow NHS Board principles;
  • consider how the Board monitors feedback from patients and what actions are then taken; and
  • make yourself visible and approachable to staff and members of the public.

Further information

The NHSScotland knowledge network has a range of resources that can help Non-Executive Directors develop their knowledge and skills:

Other useful reading materials

NHS Leadership Academy, 2013, Healthcare Leadership Model: The nine dimensions of leadership behaviour, (online)

Nolan Principles of Public Life

Scottish Government. Delivering quality through leadership: NHSScotland leadership development strategy [online]. 2012


Email: Sarah Hildersley