Purpose – This paper sets out to contribute to the advancement of knowledge, particularly with regard to the processes of implementation and the role of managers engaged in such high commitment strategies and work practices.

Design/methodology/approach – This study is part of a research project investigating the extent to which employee involvement predicts job performance (as well as job satisfaction, wellbeing and organisational commitment) in the NHS, using both quantitative and qualitative methods. The main focus of this paper is to present evidence from four of the 20 case studies to show the barriers to implementing employee involvement as well as highlighting the techniques and practices that have proven to be most successful.

Findings – Employee involvement is used successfully by management and has enabled frontline staff to contribute their knowledge to their work.

Research limitations/implications

– The ethical issues of confidentiality and anonymity permeated the research process throughout.

Practical implications – The link between “high commitment” strategies and organisational performance is of great interest to academics and practitioners alike. One of these “high commitment” strategies, namely employee involvement, has been an important HR strategy for the NHS in the UK.

Originality/value – Other organisations can learn from the findings by implementing the successful parts.