Seven Principles for Improving Service and Patient Satisfaction


A systematic approach that follows these seven principles can help you translate patient feedback into improved service.

Fam Pract Manag. 2016 May-June;23(3):15-19.

Author disclosures: no relevant financial affiliations disclosed.

Patient satisfaction scores are increasingly affecting reimbursement for medical care as value-based purchasing becomes more prevalent. Succeeding in this payment model requires physicians and their organizations to first understand how patients judge service quality and then to take a systematic approach to using patient feedback to improve service.

All customers form opinions about service quality by comparing their preservice expectations to their actual experience and assessing the result.1 If an experience meets or exceeds expectations, the customer perceives good service. If an experience falls short of expectations, creating a “customer gap,” the customer perceives poor service. Most patients lack the technical knowledge to judge the quality of their medical care, so when asked on a survey to rate “overall quality of care,” they often reflect on the service experience. With every interaction, patients form opinions about quality based on staff empathy, service attitude, and friendliness, as well as provider communication skills and practice efficiency. There is no better way to evaluate the impact of service quality on the care experience than to ask our patients.

In this article, we share Mayo Clinic Arizona's (MCA's) seven-prong model for improving service quality,2 as well as several tools we used and lessons we learned implementing the model in our family medicine practice.

The general principles and advice can be adapted to suit medical practices of any size. (See “Challenges and advantages for small practices.”)


The basic tenets of this model for improving service and satisfaction apply to practices of all sizes; however, the implementation may look different for small practices. For example, most small practices do not have a staff member whose primary role and expertise is leading service improvement. Instead, they may need to tap the service passions of an existing employee, perhaps a practice manager or someone with prior customer service or teaching experience who could help improve service. This person should be somewhat analytical, have good communication skills, and be knowledgeable about how the practice operates.

Similarly, small practices are not likely to have the data measurement and analysis capabilities of a large organization, so they may need to contract with a consultant or perhaps a local university to obtain those services.

Although small practices certainly have unique challenges when it comes to improving service, it should be noted that they also have unique advantages. For example, quicker decision-making capabilities, less bureaucracy, smaller patient populations, and greater transparency may make it easier to identify, buy into, and act on improvements.

The seven principles

Our model for improving

About the Authors

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Jon Nordrum is an administrator at Mayo Clinic Arizona, with experience in both primary and specialty care practice management. He is also an instructor in physical therapy at Mayo Clinic College of Medicine....

Denise Kennedy is the service administrator at Mayo Clinic Arizona. She is an assistant professor of healthcare systems engineering at Mayo Clinic College of Medicine.

Author disclosures: no relevant financial affiliations disclosed.


Editor's note: For another perspective, see “The Problem With Patient Satisfaction Scores,” FPM, January/February 2016.



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1. Parasuraman A, Zeithaml VA, Berry LL. A conceptual model of service quality and its implications for future research. J Marketing. 1985;49:41–50....

2. Kennedy DM, Caselli RJ, Berry LL. A roadmap for improving healthcare service quality. J Healthc Manag. 2011;56(6):385–400.

3. Beeson SC. Practicing Excellence: A Physician's Manual to Exceptional Healthcare. Pensacola, Fla.: Firestarter Publishing; 2006.

4. Kennedy DM, Nordrum JT, Edwards FD, Caselli RJ, Berry LL. Improving service quality in primary care. Am J Med Qual. 2015;30(1):45–51.


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