Hospital Trust Boards in the English NHS have statutory responsibility for upholding quality and safety of care in their organisation. Recent high-profile reports into serious failings in standards, most notably at Mid-Staffordshire NHS Trust, raise concerns over the ability of Trust Boards to discharge these oversight duties effectively (Francis, 2013). Despite a plethora of guidance on effective Board governance (NHS Leadership Academy, 2013), significant gaps remain in our understanding of what Board governance looks like, and the organisational processes and cultures through which it is discharged (Millar, Mannion, Freeman, & Davies, 2013). The literature on Board governance of patient safety consists largely of quantitative cross-sectional surveys, predominantly undertaken in US acute healthcare settings (Jha, Li, Orav, & Epstein, 2005; Jha & Epstein, 2010, 2012, 2013; Jiang, Lockee, Bass, & Fraser, 2008, 2009; Jiang, Lockee, & Fraser, 2011). While qualitative and case-study research is beginning to emerge (Baker, Denis, Pomey, & MacIntosh-Murray, 2010; Ramsay, Magnusson, & Fulop, 2010; Mannion et al., 2015; Mannion, Freeman, Millar, & Davies, 2016; Freeman, Millar, Mannion, & Davies, 2016), further study of the practices undertaken in the boardroom is needed to provide insight into the exercise and experience of patient safety governance; the micro-processes associated with Board oversight (Dixon-Woods, Leslie, Bion, & Tarrant, 2012).