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John W. Kenagy, MD, MPA; Donald M. Berwick, MD, MPP; Miles F. Shore, MD

JAMA. 1999;281:661-665.

Although US health care is described as "the world's largest service industry," the quality of service—that is, the characteristics that shape the experience of care beyond technical competence—is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.

Author Affiliations: Harvard Business School, Boston, Mass, and University of Washington School of Medicine, Seattle (Dr Kenagy); Institute for Healthcare Improvement, Harvard Medical School (Dr Berwick); and Harvard Medical School and John F. Kennedy School of Government, Harvard University (Dr Shore).

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