Domain 3 is about the strategy itself and the evidence that it worked. This domain asks whether the board's priorities are focused and collectively owned, and whether it can demonstrate that its leadership changed something. The intelligence that informs the strategy belongs to domain 2; the relationships that deliver it belong to domain 4.
Score 1: Not evident
The board's strategy contains a wide range of priorities, reflecting the breadth of partners' interests rather than a focused collective judgement about where the board can make the most difference for population health and wellbeing and wellbeing.
The board has not applied a clear test to distinguish what it can lead directly, what it should support and resource, and what it should monitor without directing, and energy is dispersed accordingly. There is no small number of board-owned priorities that members are jointly accountable for advancing.
Performance information is presented to the board but not used to challenge direction or drive decisions. The board cannot readily point to changes in what organisations do, or in what populations experience, that resulted from its decision-shaping influence and would not have happened without it.
The link between the board's stated strategy and what actually appears on its agenda is loose.
Score 3 note: Growing
The board has narrowed its priorities and can articulate why these and not others.
It is beginning to differentiate between what it will drive directly, what it will sponsor and resource, and what it will observe and receive assurance on: the Drive, Sponsor, Observe framework, or an equivalent, is helping it manage its strategic focus. Some progress against priorities can be evidenced, and the board is beginning to have honest conversations about the limits of its influence.
Score 5: Embedded
The board has a small number of focused, evidence-based priorities that are stable over time and that reflect a clear judgement about where its decision-shaping leadership will make the most difference to population health and wellbeing outcomes and health inequalities.
Every member can describe these priorities and articulate their own organisation's specific contribution to advancing them.
The board is explicit about how it relates to each area of its work: it distinguishes between priorities it will drive directly, areas where it will sponsor and resource but not lead, and activity it will observe and receive assurance on without directing. This discipline prevents drift and protects the board's attention for the areas where only it can make the critical difference.
The board can point to specific changes in decisions, services, resource allocation or community outcomes that resulted from its leadership and would not have happened without its orchestration. Its measure of success is not what programmes it has delivered but what different decisions partner organisations have made as a result of how it has shaped the system's understanding of population health and wellbeing priorities. It tracks progress against a small set of agreed metrics regularly; the quality of that review conversation matters more than the frequency. The board is willing to stop doing things that are not working, and to say so. The strategy is tested against the question of whether it is making a difference to the people experiencing the worst health outcomes, not only to the system as a whole.