Building better Boards: Key challenges and insights for scaling companies

Last week I was lucky enough to meet the last three cohorts of the NHS Innovation Accelerator. Mindy Simon had asked me to put together some ideas on building boards – and then perhaps as a throw away comment said, “You must have a few horror stories”.

Horror stories may be a step too far, but definitely some lessons have been learned from working very closely with CEOs and boards as Health and Tech companies scale. The discussion seemed to go down well with the group so I thought documenting it here might be useful for others.

First an apology – I have never started or run a company. I have also never formally sat on a board. So all of the below is knowledge shared by others. Primarily CEOs who shared their experiences of working with their first board. Many of them also shared success stories of moving from a board which they struggled to deal with to one that they feel adds real value. Writing this is a small part of helping on that journey.

(at least) 6 key challenges

I anchored the discussion around six key challenges CEOs have shared with me about their boards as they (as CEOs) and their companies mature. They are:

1. When I look at my board, and look at my strategy…I struggle to see the overlap
2. I wish my board had been more direct and told me – good idea, bad idea…they were over supporting and under directive
3. When I bring challenges or problems to the board…I leave with more
4. I used to dread board meetings…and lose 1 day per week preparing
5. A board member asked “What are we doing on generative AI?”... I didn’t know if that was curiosity or the need to complete an assignment
6. That didn’t go as expected

While these are not mutually exclusive challenges, each are real challenges CEOs, particularly first time CEOs, grapple with.

Let’s dive into each:

1. When I look at my board, and look at my strategy…I struggle to see the overlap

Many boards, particularly early-stage venture boards which tend to be made-up of investment director only, don't always have lived experience of sector specific and deeply technical growth challenges that CEOs are facing on a day-to-day basis.

This can result in the CEO looking to the board to provide a higher level of insight on decision making which may be beyond what is possible.

Some Investor Directors will have seen numerous founders scale a business and know how best to guide and coach them, even if the sector specific context is missing. Many of our discussions with CEOs and boards today point towards establishing advisory boards or independent board directors earlier to support the CEO and derisk the growth journey.

2. I wish my board had been more direct and told me – good idea, bad idea…they were over supporting and under directive

Linked to point 1, it was fascinating to listen to one CEO almost regret the level of support they got from the board, instead wishing they would have steered the strategy more, given their subject matter knowledge.

Investors tell us time and time again that they invest in the people with the technology being a close second. It's natural therefore for boards to be supportive and enabling of CEOs and founders, but hindsight would suggest that there is a good balance to be had between support and absolute direction.

3. When I bring challenges or problems to the board…I leave with more

For those that have not worked with a board before, they often see it as the equivalent of an Olympic standard rifle shot - betting everything on one three-hour meeting. The feeling of walking out of the board meeting without the issues resolved, and with more issues to deal with, can be incredibly demoralising.

An early lesson for CEOs is that the more boring the board meeting, the better. The most straightforward way to achieve this is to maintain high engagement with board members outside of the on-calendar board meeting. That leaves few surprises and very little debate to be had with the board and time to focus on the exceptions rather than trying to focus on everything.

4. I used to dread board meetings…and lose one day per week preparing

One of the most disheartening stories comes down to the simple truth; that early-stage founders can lose hours and often days preparing for board meetings. Add to this that some founders feel these meetings are at best unproductive, and in the worst case, removing value from the business.

Founder time is one of the most critical resources in any early-stage company. Every single early-stage founder I speak to would dream of an extra day a week to drive founder sales, hire brilliantly or improve the business operationally.

5. A board member asked “What are we doing on generative AI?”... I didn’t know if that was curiosity or the need to complete an assignment

During the session with the NHS Innovation Accelerator, a founder raised their hand and asked what I've seen when it comes to the power dynamic between board and CEO. In some ways everything we've discussed so far relates to a power dynamic.

However good board governance can create clarity between simple curiosity and specific actions. The example above is a question every board should be asking given the apparent acceleration and adoption of generative AI, and now agentic AI. The downside is the answer to this question may not be simple or quick. Ironically the better question may be CEOs approaching their board to say, “What should we be doing about generative AI?”

6. That didn’t go as expected

At the end of last week’s session, someone approached me and asked, “Are boring boards better?”. My answer was “Not necessarily, but there is a very fine line between excitement and unpredictability”. Many CEOs in our network tell us that through hard work and time, they now have a value adding and highly effective board.

The hallmarks of that are around strategic focus and a strong return on investment on both time and money. The focus of the board meetings is not about page turning and sifting through the finer points of the board deck, that is almost a prerequisite for being in the board meeting. Rather than look back and look down, the board is an opportunity to look forward and look up.

One CEO said the message to their board was “You’ve got the deck, unless there is something you want to discuss, we will not step through it. And here are three big decisions or challenges I need you to help me solve…”

What's next?

Next week, Ian will share the draft framework that looks to address some of these real-world challenges, which is something that will be built up with academic research over the next 12 months. Stay tuned!