Performance measures are all very well, but true success stems from staff who believe in and are part of organisational achievements. Here Derek Mowbray maps out the route to achieving this.

People working in high-performing organisations are attracted to them, remain in them and improve their own and the organisation's performance. Staff can more readily adapt to change when the organisation has a clear purpose, a culture of commitment and trust, and encourages behaviour that treats all staff as citizens of the organisation.

However, the NHS has particular challenges in achieving high performance.

There often appears to be no single organisational purpose, but many ambiguous performance measures.

There are frequent large-scale changes, an increasing awareness of clinical and other errors, more litigation cases, patches of very high levels of workplace stress and high vacancy levels.

The NHS is also vulnerable to poor media portrayal.

So what are the characteristics of highperforming organisations? They boil down to the existence of a climate that engenders commitment from the workforce. This goes beyond the personal and professional commitment to the patient or client, and to a commitment to the purpose, aspirations and separate components of the organisation.

For the NHS, the existence of organisational commitment by its workforce is becoming increasingly important and significant. For example, with the expansion of commercial organisations there are more alternative employment opportunities in healthcare.

There is also a fear of errors. With increasing specialisation of clinical services, more general-level services are being provided by less developed practitioners. A potential rise in clinical and other errors is an increasing risk. The stress this causes practitioners is enormous.

Among all staff there is an unrelenting pressure to improve services, create effective networks and partnerships, interpret frameworks and guidance, and bring policies to life. The short times allowed to achieve these aims can lead to stress, absence and rising vacancies.

On the other hand, an organisation with a committed workforce will have low stress levels, a sense of involvement, the ability to act with personal discretion, effective team-working, mutual support and a sense of fun. The key elements of organisational commitment and trust are:

l The 'big idea' - a clear sense of organisational purpose embedded throughout the organisation, reflecting purpose, values and mission.

l Organisational architecture - less bureaucratic structures to encourage personal discretion in decision-making.

This leads to greater organisational trust and reduced risk to patients.

l Training and development - ensuring that staff have the skills, knowledge and experience to do what is expected of them, not simply attending training programmes for the sake of it.

l Rewards and recognition - pay that fairly reflects employees' responsibilities, and performance appraisals that focus on contributions to organisational success.

l Communication - processes to involve staff in development and performance.

l Career opportunities - opportunities for staff to develop in ways unforeseen at the time of recruitment, but which contribute to organisational trust and commitment.

l Management encouragement - urging staff to take measured risks and act with discretion, with the help of strong managerial support.

l Work-life balance - ensuring a fair balance between personal and work demands.

l Openness - creating a culture of honesty between staff and managers, with managers encouraging self-appraisal, organisational citizenship, mutual support and innovative ideas.

The way management, leaders and staff interact is always worth paying attention to. And team working is key.

Look at how team members understand their contributions. Are they open to self and peer appraisal?

Finally, we need respect for diversity.

This manifests itself in the way people respect others' contributions and in the acknowledgement and responses each makes to the other.

Derek Mowbray is visiting professor in organisation and occupational psychology at Northumbria University and primary consultant at the Tribal Centre for Organisational Learning.