I am writing this blog sat on a ward in one of the Greater Manchester Hospitals with my wife Kirsty awaiting further exploratory tests on a suspected Gall Bladder problem (hers not mine).  Having spent most of Saturday at A&E it has been an interesting few days – not least because we have been experiencing first hand the machinations of the NHS.  As someone who spends a lot of my time working with large organisations, with leaders and leadership teams exploring culture and behavioural change, it has been fascinating to observe first hand how the impact of this work plays out on the ‘shop floor’ as it were.

We had arrived early for the clinic and as I wandered through the hospital in search of black coffee I was really impressed by the cleanliness, the smiling faces, the banter and camaraderie amongst staff as they started (or finished) their day.  There were posters on the walls depicting the values of the trust and the commitments to delivering great patient care, brought to life with smiling faces of staff members from across the organisation.  Something I have seen, and often helped create, in many large organisations over the years; as I walked along, I was wondering how they have helped bring that to life in a way that creates the positive environment that I was witnessing.  Any process, organisation or reputation is only as strong as its weakest link, the best meal can be let down by a problem with the bill, the best city break experience ruined by an issue with the car park as you leave.  Now a fantastic meal, a brilliant hotel stay or travelling experience are not going to be made that way because of the bill, the car park or the speed of luggage retrieval, but they can be spoilt because of these experiences – it is the little things that matter.

As I sat, I reflected on a couple of experiences I had observed – watching a nurse take Kirsty’s blood pressure with a sophisticated electronic machine, taking care to get it right and ensure Kirsty was comfortable, but then having finished, stuffing the cables and cuff roughly back into the basket attached to the machine.  It was interesting, there is clearly a really strong focus on the patient experience at hand, but what about the potential damage to the equipment which might impact future patient treatment? Alternatively I had watched the porter who came to collect Kirsty on Saturday evening ask her if she would be more comfortable with a wheelchair rather than walk down to X-Ray. It made me think about that behaviour and the implications for the wider attention to detail and care of both patient and equipment, here was an example of the little things that matter.

If culture is ‘the way we do things around here when no one is looking’ the little things are a prime example of the underlying culture and the real impact of the leadership rhetoric, action and focus.  In my experience of working with teams from across industry sectors I have seen plenty of great stories and grand programmes driven from the top of the organisation to change culture, some succeed but most fail because they are typically one dimensional.  Organisations are complicated and complex beasts, a multi-dimensional system that needs to be treated accordingly if you are going to change the ingrained behaviours and ways of working.  In my experience there are a number of ‘levers’ one can pull or tweak in order to get the results you want, not addressing all of them can leave you risking failure.  The Kili Consulting 9 Levers for Change is an approach I have developed over the years and has been instrumental in driving successful culture change across industry sectors.

Whether it is about putting the patient first or developing a health and safety culture it will be the little things that make the difference, aggregated, over time it is the little things that become ‘the way we do things round here when no one is watching’.  We walk down the stairs holding the banisters, we reverse into car parking spaces, we always thank our staff members at the end of the day, we celebrate success at every opportunity or we ask for feedback from our customers and listen to the response.  Aligning your culture means aligning your people in the way they behave and this can be one of the most powerful opportunities for competitive advantage.  But culture isn’t the preserve of large corporates – in your little team, your part of the office, your running club, your social group, your family there is a way things get done when no one is looking – is it always the way you want? Are you focussing on the little things?