Within your process to be improved, there are multiple internal suppliers and customers. A customer is anyone who depends on you for your work. Suppliers supply whatever you need to do your work. A flowchart will help to define these relationships and hand-offs.

At the end of every process is the Ultimate Customer, waiting for the result of the entire process. Quality is defined /judged by the customer. For example, if the process is Lab Tests and the Physician is the customer, they may define quality as timeliness and accuracy.

Knowing your customers better allows you to select measures that are meaningful. There are numerous methods for acquiring customer knowledge, from written or in-person surveys and checklists, to informal conversations and trading places (mystery shopping). Marketeers are leaning away from more formal methods to Observation, Video, and Dialogue. Nothing speaks louder about service than being a patient or shadowing one. Here are some of the many tools:

• Focus Groups
• Surveys (Mail, Phone, Informal Poll, Key Informants)
• Checklists
• Mystery Shopping
• Customer Advisory Panels
• Toll-free Hotlines
• Benchmarking
• Process Walk-throughs
• Unobtrusive Measures
• Observation
• Complaint/Suggestion Systems
• Formal Needs Assessments
• Customer Murmur Log (when they speak spontaneously, write it down in a log book)
• Conversations
• Kano Survey Method (must-be, nice-to-have, and surprising, attractive quality)