I love the contrast between Ramsay's UK series and his American-set ones. I'm sure a lot of it can be chalked up to cultural expectations (e.g. UK reality shows that don't have Simon Cowell as a host feel a lot more leisurely and documentarian in approach, while American reality shows are full of drama and urgency and pro-sports-style competitiveness), editing, slanted selection process, etc. But in the British Kitchen Nightmares, the owner and their staff are usually competent in the fundamentals of running a restaurant. They're just hung up on some misguided marketing, or hideous decor, or insist on having a gigantic menu to appeal to all kinds instead of getting a handful of offerings perfect, etc. Usually these get resolved by Ramsay sitting down for a congenial chat, amounting to, "mate, you need to fix this."
In the American version, Ramsay frequently shows up at mom-and-pop passion projects who often don't seem to know what they're doing. Ramsay has to talk to them like they're small children to get them to fix fundamental issues, and looks tortured when they don't seem to understand.