The results of this year's Healthcare Commission staff survey should serve as a wake-up call for anyone with a passion for a world class healthcare system that performs at its peak, writes Derek Mowbray

Manager-staff relationships are central to such an organisation, as measured by levels of sickness, absence, staff turnover, clinical and other errors and accidents.

Organisations that foster a culture of trust, commitment, employee engagement and strong individual psychological contracts achieve optimum performance. Investment in review of purpose, structure, and "rules" that govern behaviour yield larger benefits than pursuing a process of supporting people who suffer from bullying, harassment, poor communications and interaction breakdown.

Investment in management behaviour that promotes trust and commitment will yield staff engagement, increased productivity and involvement in the organisation's future, leading to retention of staff.

The behavioural techniques required can be taught. Managers need to interact successfully with people, and, therefore, need to develop the skill of attentiveness to their needs, demands, interests and performance, and the ability to entice staff towards achieving greater success through more effective performance. Bullying and harassment and the other symptoms of manager failure should be prevented before they can occur.

Dr Derek Mowbray, director, Centre for Organisation Health