NHS Boards are accountable for using the finite resources available to deliver best value for their organisation and the local population, working collaboratively with other organisations, across the wider integrated care system. We analyse how the decision-making process can be adapted to enable good boards to become great boards and how they can balance competing demands and priorities. By the end of the interactive session, you will be more aware of how NHS boards manage their public accountability for the holistic performance of their organisation, and contribute to the wider health and care system, within a complex regulatory and financial framework.