The importance of 'tiny, apparently meaningless' conversations

case studyWhat follows is a commentary by The Guardian Society Daily blog editor, Patrick Butler (to whom thanks) on The importance of tiny conversations

Sometimes it’s tiny, apparently meaningless conversations and formalities that matter when it comes to forming an opinion about whether a public service is “good” or not. Sometimes it’s not the words but the tone and the manner in which they are delivered that tells you something profound about the nature of your relationship with the service you are using, particularly if it is a ‘care’ service.

So even if it’s a good, efficient service, you might go away nursing ambivalent feelings about your overall experience. A relative of mine, in his 80s, who recently had to spend two days in hospital came away incensed by the way the nurses referred to him by his first name, rather than the “Mister + surname” formula. He was sure they thought they were being breezily cheerful: to him it felt disrespectful and patronising, as though they were treating him as a helpless child.

Here’s a couple of other examples of “tiny conversations” that I’ve come across online recently.

First, a typically thoughtful reflection [on Ethnic Origin ] from social worker blogger Fighting Monsters describing one such “little conversation” during a recent hospital visit. And second, this posting on the excellent Patient Opinion website, from a hospital patient utterly dismayed and confused by the assumptions of a doctor at North Durham University hospital. I’ll reprint it in full:

“I was admitted to hospital with sickness, dizziness and low blood pressure.
I was examined and put on the medical admission ward. I was put on a drip and antibiotics for a few days. I was seen by a few doctors whom I felt none explained to me what could be wrong with me as I was very poorly.
Then a doctor came to me and said, “I have read your file and realised that you are gay and so I have arranged for you to have a HIV test tomorrow.”
I was deeply offended about this as she did not even ask anything about me or my very long-term partner of 22 years and consequent marriage.
Before I had a chance to say anything further to her, she walked away and so I ask three different nurses to ask her to come and see me again but she never did. I think this is outrageous and unfair.
Does anyone know whom I can make a formal complaint to?”

Now, that’s one side of the story, obviously, and the hospital hasn’t yet responded to the post (and that’s the beauty of Patient Opinion and web 2.0, that the hospital can not only be held accountable but can fulfil its duty of accountability, personally and in public, and in more-or-less real time). But you can see why the patient is angry.

By the way, it’s well worth a trawl through the posts on Patient Opinion: it’s not, as some may fear, a whingers’ charter, but full of accounts of good experiences. A not uncommon sentiment is:

“I can’t praise the staff highly enough.”

These are all real-life small conversations, assisted as Patrick Butler says by the latest in web technology.

What can we learn from these conversations, and how can they best become part of the move towards bigger sustainable change?


Posted on May 18, 2010, in Real-Life Examples and tagged , , , , , , . Bookmark the permalink. 1 Comment.

  1. Daniel Gilbert

    Hi, Hilary

    Great theme here and I couldn’t agree with you more! Picking up on the tone of conversations is vital to how customer service is actually experienced, and can be far more important than more tangible aspects of quality. Quality frameworks are notoriously awful at picking this up, not least because what they measure is determined by what they look for, and whether staff look like they actually mean the words that they parrot out is a level of sophistication beyond most quality frameworks.

    I would like to that this opportunity/ excuse to highlight the excellent thoughts of David Snowden on one such quality framework, namely Six Sigma, or “Six Stigma” to give it his rendering. A wonderful entertaining thought piece on this subject is available on his blog at

    Six Sigma comes to mind as it is very thorough at measuring production-related elements of quality, i.e. the basic product. However, this typically does not even take you as far as the quality requirements of the expected (by the consumer) product, e.g. that it is delivered on time, all together, and to the right address. Companies will usually consider failings in this regard as not their failings, but rather the failings of the courier firm concerned. However, the consumer views the failings to be that of the supplying company, as that is who their (unfulfilled) order was placed with. Next up comes the conversation between consumer and supplying company where the former is irate and the latter (in the form of an overworked and underpaid call centre employee) very obviously goes through the motions of apologising, but with no conviction in their voice.

    Result: complete failure of quality of customer service, not picked up by 6 Sigma as applied generally, partly as a result of a rubbish courier firm (in this and many other examples) and compounded by a failure to communicate with customers in a genuine fashion.

    By the way, I hear that our government is hiring expensive 6 Sigma “experts” to help with the cost cutting, on the basis that this methodology is a great way of cutting costs. Beyond the obvious conclusion of “God Help Us” is the rather amusing aside that 6 Sigma is generally seen as a way of cutting overhead, first and foremost, and a quality enhancement tool only at a secondary level.

    Keep up the good work, Hilary!

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