The people of Hounslow, west London, have been impressed by a street cleaner who dances like Michael Jackson. This is either the council chief executive on a back to the floor initiative thinking about how much his contract is worth, or an extremely engaged employee.

Engagement drives the nation on. The people of the UK appear to be profligate joiners: on average, every adult is a member of 18 organisations, from supermarket loyalty cards to local residents' associations. Some are even members of political parties.

There has been a government campaign for involving staff in running their organisations across the public sector for the past 10 years, in the NHS in particular. This resulted from the realisation that improving the quality and accessibility of services would not be solved just through more funding.

The Department of Health has published research as part of the next stage review, looking at what affects staff in the health service. Based on surveys and group discussions, the research identified 10 factors that summarised what matters most to staff. Crucial factors were involvement, including being treated with trust, being listened to, understanding the big picture and working together. So a worthwhile, supported, well resourced job with opportunities is what does the trick.

The analysis comes up with some categories into which staff fit according to their level of engagement. An employee can have a relationship with their department, hospital or trust as well as the NHS. Feeling involved, a strong relationship with your line manager and the chance to contribute to management decisions all drive performance.

Less motivated staff are either "bystanders", who keep their heads down; "disenfranchised", who do not feel part of the system; or "spoilers", who are individualist and resist change.

The most positive are the "champions", who have a strong sense of responsibility and feel in control of their destiny and actions.

The line manager makes the greatest difference to the employee's working life. Staff want to see a clear connection between what they are doing on the front line with the overall strategy of their employer.

PricewaterhouseCoopers has defined employee engagement, describing its philosophy in this way: "Employees are rented not owned - engagement can only be volunteered, not conscripted." Its strategy includes measuring employee attitudes, building on good people management and recognising potential engagement drivers.

These ideas are not new. In the mid-1950s at the Esso oil refinery in Hampshire, trade unionist Sir Leonard Neal established a wages and productivity agreement that recognised progress could be made for all sides through co-operation.

The ultimate form of engagement must be when clinical staff take up leadership positions - whether on a team, trial or indefinite basis. This means being accountable for change management and delivery - improving decision making that enhances how much other staff get involved.

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