Few organisations have to deal with change to the extent that the National Health Service does. From new government targets and leadership academy initiatives, to the more recent clinical and nurse revalidation, the latest priorities seem to arrive nonstop. As such, a large employer can find delivering change effectively extremely challenging, and any tool that aligns staff and aids communication is going to be valuable. Systems like ESR do have value, but they are only repositories for data as opposed to behavioural enablers. Embedding the right performance review system can address a number of relevant challenges but how can we make the business case for a performance review system in the NHS?