Introduction Organizations are increasingly coming to the real- ization that sound internal communications are central to their overall efficiency and effective- ness (Stayer, 1990; Clampitt and Downs, 1993; Tourish and Tourish, 1996). For example, Hanson (1986) found that the presence of good interper- sonal relationships between managers and staff was three times more powerful in predicting profit- ability in 40 major companies over a five-year period than the four next most powerful variables combined – market share, capital intensity, firm size and sales growth rate. A recent study by Pettit, Goris and Vaught (1997) established that proper, correct and clear information is positively con- nected to job satisfaction and productivity, though the precise nature of that relationship requires further investigation. More broadly, some US surveys have suggested that, by the late 1980s, roughly half of all large unionized manufacturing firms had instituted employee involvement or participation pro- grammes, such as problem-solving task forces, quality circles and self-managing work teams (Delaney, Lewin and Ichniowski, 1989; Cook, 1990). Involvement and participation have at- tracted a huge volume of research literature (e.g. Guzzo, Jette and Katzell, 1985; McCabe and Lewin, 1992; Blyton and Turnbull, 1994; Hyman and Mason, 1995). The weight of the evidence has suggested that they have, when properly de- signed and implemented, improved performance (Sashkin, 1986; Pfeffer, 1996). For instance, Miller et al. (1990) surveyed over 700 people in one large organization. They found that participation in decision-making and the existence of social support reduced workplace stress and burnout, British Journal of Management, Vol. 9, 53–71 (1998) Communication between Managers and Staff in the NHS: Trends and Prospects Dennis Tourish and Owen D. W. Hargie School of Behavioural and Communication Sciences, University of Ulster, Newtownabbey, County Antrim BT37 0QB, Northern Ireland, UK The importance of the role of communication in the success of individual performance in social and business life is now widely recognized. Within organizations, effective internal communication between managers and staff is vital to organizational success. This is particularly so during periods of change, when staff uncertainty increases and there is an increased need for greater amounts of information and more frequent com- munication. Staff in the NHS have recently experienced some quite dramatic changes in their working practices. This paper therefore examines the current state of communi- cation within the NHS and the implications which this poses for the overall functioning of the organization. In particular, the relationship between communication and the motivation of staff is described. The nature of communication audits, the main research approach used to assesses communication effectiveness, is then delineated, and areas of the NHS chosen for analysis by this means are proposed. The results of a series of audits are summarized. Problems in information flow, use of information sources and channels, the timeliness of information exchanged, the extent to which people send in- formation to each other and the quality of working relationships are identified. The implications of these findings for the NHS and general views of management are considered. Keywords: Profitsharing, professional firms, incentives, cooperation © 1998 British Academy of Management