ABSTRACT
Health care scandals, such as the most recent at Mid Staffordshire in the English NHS, have demonstrated that uncaring and ineffective practices can flourish in hospitals when the organisational context goes wrong. When this happens, patients not only have unpleasant experiences during care but they can be hurt or even die as a consequence. Addressing quality and safety failings has emerged over the past few decades as one of the key challenges in modern hospital management, and it is clear that these challenges are not confined to a few 'failing' organisations but that they are (a) endemic and (b) embedded in system arrangements and organisational practices. Effective Board oversight of safety also requires attention to be paid to dynamics and tensions within and between Boards, medical staff and senior leaders. Hospital Boards as corporate entities have a fundamental strategic role in developing the strategy, systems and cultures for their organisations.
