Occupations and Terms of Reference › Board chair
Universal terms of reference · POS-002 · version 1.0 · status: draft · next review 2027-10-27
Board chair
To lead the board so that it works effectively, makes sound decisions, holds the chief executive to account, and keeps the organisation focused on patient safety.
Each part of this page links to the related trainings, competencies and policies. The links are the same for every facility, so an organisation can see at a glance what a role requires and what it is trained in.
Job description
Job summary. You lead the board. You set the agenda, chair meetings, make sure all members are heard, keep the board focused on patient safety and strategy, and lead the annual review of the board and the CEO.
Reports to: Board of directors.
Leads or supervises: The board members (as a group).
What you do on a typical day
- Agree the board agenda with the CEO before each meeting.
- Chair board meetings and make sure decisions are clear.
- Meet the CEO between meetings to review performance.
- Lead the annual board self-assessment.
- Represent the board to owners and external partners.
Working conditions and demands
- Time commitment is significant and often unpaid.
- Balances independence with support for the CEO.
- Must manage conflicts and difficult conversations.
What good looks like
- Meetings are well run and every member contributes.
- Patient safety is a standing item on the agenda.
- The board reviews its own performance each year.
Place in the organogram
Reporting line, from the top: see the organogram on the Occupations page. The lines above and below this role are listed in section 3.
1. Golden rules
These rules apply in every setting.
- Every decision that affects patient safety is made on evidence and recorded.
- Patient safety and quality come before financial targets; no trade-off that puts patients at risk is accepted.
- Every staff member can raise a concern without fear of reprisal, and every concern is answered.
- Legal, licensing and accreditation duties are known, owned and reviewed.
- Finances, people and information are managed openly and within the law.
- Mandatory training and policies apply to the executive as much as to frontline staff.
2. Identification
| Item | Detail |
|---|---|
| Position code | POS-002 |
| ISCO-08 | 1110 (skill level 4) |
| ESCO | to map |
| Department | Governance |
| Facility types | Hospital, Ambulatory, Transport, Medevac, Fitness, Aesthetic |
3. Reporting line and working relationships
Reports to: POS-001. Supervises: POS-001.
| Works with | Nature of the relationship |
|---|---|
| Chief executive officer | Regular meetings on the agenda and performance. |
| Board of directors | Chairs meetings and leads board development. |
| Owners and shareholders | Represents the board to owners. |
4. Key accountabilities
| Domain | Accountability | Evidence of delivery | Checked | Linked competencies | Linked trainings | Linked policies | Standards |
|---|---|---|---|---|---|---|---|
| Board process | Sets agendas, chairs meetings and ensures decisions are recorded. | Agendas and minutes issued on time | Quarterly | C-01 | T-06 | – | 1 |
| CEO relationship | Reviews the CEO's performance and objectives each year. | Annual review completed and recorded | Annually | C-02 | T-08 | – | 2 |
| Board development | Leads the board's self-assessment and training plan. | Self-assessment completed; training plan agreed | Annually | C-01 · C-02 | T-06 | – | 2 |
| Safety oversight | Makes sure patient safety is a standing board item. | Safety item on every agenda | Quarterly | C-03 | T-05 | POL-INC | 2 |
5. Decision rights
| The post holder decides | Consults or escalates |
|---|---|
| Agenda and meeting arrangements | Major governance matters for the full board or owners |
| Board committee structure within the constitution | Disputes between board members or with the CEO (board and owners) |
6. Qualifications and experience
| ID | Qualification | Mandatory | Validity |
|---|---|---|---|
| Q-01 | Degree or equivalent professional experience relevant to governance | Yes | Lifetime |
| Q-02 | Chair or board leadership training | No | Lifetime |
| ID | Experience | Minimum years | Mandatory |
|---|---|---|---|
| E-01 | Board or executive leadership experience, ideally in health or a regulated service | 10 | Yes |
7. Training requirements
Recommended common practice. Each facility adapts the list to its national law. Essential items apply in every setting; recommended items apply where resources allow.
| ID | Training | Tier | When | Validity | Linked policies | Linked competencies |
|---|---|---|---|---|---|---|
| T-01 | Facility induction | essential | at_entry | Once | POL-WHISTLE · POL-EQUAL · POL-DATA | – |
| T-02 | Safeguarding adults | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-03 | Safeguarding children | essential | periodic | Every 3 year(s) | POL-SAFEG | – |
| T-04 | Data protection and confidentiality | essential | annual | Every 1 year(s) | POL-DATA | – |
| T-05 | Incident reporting and open disclosure | essential | periodic | Every 2 year(s) | POL-INC | C-03 |
| T-06 | Governance, accountability and assurance | recommended | periodic | Every 3 year(s) | – | C-01 |
| T-07 | Emergency and major incident command | essential | annual | Every 1 year(s) | POL-INC | C-03 |
| T-08 | Speaking up, inclusion and equality leadership | essential | periodic | Every 2 year(s) | POL-WHISTLE · POL-EQUAL | C-02 |
8. Health, fitness and language
| ID | Requirement | Frequency | Tier | Minimum in low-resource settings |
|---|---|---|---|---|
| H-03 | Fitness-to-work assessment at entry and after serious illness or injury | Every 12 months | recommended | Fitness check at entry |
| Language | Level | Mandatory |
|---|---|---|
| Official language of the country of practice | professional | Yes |
| English | working | Yes |
9. Competencies by level
| ID | Competency | Foundation | Practitioner | Expert | Assessed by | Revalidate | Linked trainings |
|---|---|---|---|---|---|---|---|
| C-01 | Chairing and board process | Participates in meetings | Runs an effective meeting | Leads board processes and succession | Board review | Every 24 months | T-06 |
| C-02 | Leading the board and the CEO relationship | Works constructively | Leads difficult discussions | Builds a high-performing board | 360 feedback | Every 24 months | T-08 |
| C-03 | Oversight of patient safety | Understands safety reports | Asks the right safety questions | Ensures the board oversees safety effectively | Board review | Every 24 months | T-05 · T-07 |
10. Performance evaluation
- Probation: 6 months, with a sign-off review (recommended value).
- Appraisal: every 12 months against the competencies and indicators below.
| ID | Indicator | Target | Data source | Frequency |
|---|---|---|---|---|
| PI-01 | Board meetings held with agenda issued in advance | 100% | board calendar | Quarterly |
| PI-02 | Board self-assessment completed | 100% | self-assessment record | Annually |
| PI-03 | CEO performance review completed | 100% | review record | Annually |
| PI-04 | Safety item on every agenda | 100% | minutes | Quarterly |
11. Career ladder and promotion
| Level | Role | Minimum experience to move on | Qualifications | Competency minimums | Trainings required | Assessment |
|---|---|---|---|---|---|---|
| Executive | Board chair | 10 years (recommended) | Q-01 | C-01 expert, C-02 practitioner | T-06 | Executive appointment and performance review |
12. Policies the post holder follows
Each policy is a standard template that the facility adopts and adapts. Templates are maintained centrally, so every facility works from the same version.
POL-SAFEG · Safeguarding adults and children
Purpose: Protect patients from abuse, neglect and harm, and make sure every concern is recognised and acted on.
Scope: All staff, volunteers and contractors.
Key rules:
Scope: All staff, volunteers and contractors.
Key rules:
- Recognise signs of abuse and neglect and record them factually.
- Report every concern to the designated safeguarding lead the same shift.
- Do not investigate alone.
- Share information only as the safeguarding procedure allows.
POL-DATA · Data protection and confidentiality
Purpose: Keep patient and staff information private, secure and used only for care and legal purposes.
Scope: All staff who access records or systems.
Key rules:
Scope: All staff who access records or systems.
Key rules:
- Access only the records needed for your work.
- Keep records secure; do not leave screens or paper unattended.
- Do not share information without a lawful basis.
- Report any breach to the data protection officer within 24 hours.
Linked trainings: T-10 · Review every 12 months · Template 0.1 (draft)
POL-WHISTLE · Speaking up (whistleblowing)
Purpose: Let staff raise patient safety or conduct concerns without fear of reprisal.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Raise a concern with your line manager or the named speaking-up officer.
- If that route fails, escalate to the board or the national regulator.
- Retaliation against anyone who speaks up is a disciplinary offence.
- Concerns are recorded, investigated and the outcome given to the person raising them.
Linked trainings: T-01 · Review every 12 months · Template 0.1 (draft)
POL-EQUAL · Equality, diversity and inclusion
Purpose: Give every patient and colleague fair access, respectful treatment and reasonable adjustments.
Scope: All staff and patients.
Key rules:
Scope: All staff and patients.
Key rules:
- Treat every person with dignity regardless of background.
- Make reasonable adjustments, including interpreters, for language and disability.
- Report discrimination through the speaking-up route.
- Monitor access and outcomes by group.
Linked trainings: T-01 · Review every 24 months · Template 0.1 (draft)
POL-INC · Incident reporting and open disclosure
Purpose: Report and learn from incidents and near misses, and tell patients honestly when things go wrong.
Scope: All staff.
Key rules:
Scope: All staff.
Key rules:
- Report every incident and near miss the same shift.
- Give the patient and family an honest account and an apology where appropriate (open disclosure).
- Take immediate action to protect others.
- Learn: contribute to the review and follow the agreed actions.
13. Standards that name this role
14. Record history
| Date | Change | Approved by |
|---|---|---|
| 2026-10-27 | Draft record, batch 1 of the position build | Awaiting approval |