This paper explores employee participation in three healthcare organisations by focusing on the perspectives of senior managers and employees in a community health service, an emergency department in a large metropolitan health service and a regional hospital in Victoria. We explore their views of employee participation, their experiences of participation in practice, and the facilitators and barriers to participatory practice. We investigate a number of preconditions of participation, identified in earlier research; specifically, management support, union presence, perceived benefit, legislation and policy, and participatory ethos. Findings showed that management determined whether or not there was employee participation within the organisation. Hence we argue that management support is a necessary precondition to the establishment of employee participation, which only occurs where there is a perceived benefit to management. The other preconditions were subordinate to importance of management support. Management support and perceived benefit are the eminent preconditions that determine whether employee participation takes place.