Sweat the small stuff: a case study of small-scale change processes and consequences in acute care.

Solving small, annoying problems may appear to be unimportant in a political, demographic, and economic climate that focuses attention on radical long-term changes to the organization, delivery, funding, and regulation of the healthcare system. Most contemporary commentary emphasizes the need for large-scale, major, strategic, transformational change. Deliberately designed to focus on minor issues, however, the intervention reported here, in a hospital gastroenterology department, demonstrates how small changes generate major benefits for patients, staff, and hospital performance. This approach can also strengthen clinical-managerial relationships, which are key to larger scale changes and which suffer when 'the small stuff' is not fixed. The success of this intervention is explained with reference to a model of change combining context, content, process, and individual dispositions. The intervention, however, is easily modified to suit different contexts and was subsequently used successfully in other service areas in the same hospital. These outcomes present a challenge to the contemporary preoccupation with transformational change. Healthcare managers are thus advised, on the basis of this experience, to be alert to what appear to be minor unresolved issues, and to address these rapidly, in addition to larger scale, longer term projects.