Patient satisfaction may be the ultimate measure of quality but it is only part of the quality measurement and improvement equation. Customers may be good at telling you what needs fixing but they cannot be expected to tell you how to fix the problem. It is important to let patient satisfaction measures guide the focus of your process improvement efforts, but these efforts must include the appropriate process measurement tools. A customer-focused survey will be valid only if it emphasizes key quality characteristics (KQCs), as defined by patients. You'll need to develop a sampling plan that will produce useable data. The design of the questionnaire and the reliability of the survey tool are critical to using patient surveys for quality improvement (QI). Surveys that don't meet standard criteria have a greater potential for error. Another challenge is the report format and analysis that are used to understand the patient responses. Having an external benchmark is critical to accurate measurement in patient surveys. Comparative data can also help prioritize QI projects. In summary, a well designed patient survey system can identify key quality characteristics, determine which KQCs have the most impact, help prioritize QI efforts, and measure patients' satisfaction in a reliable manner.