Using Customer Satisfaction Surveys to Assess the Quality of Programs and Services

QI Spotlight Icon High-performing health departments continually improve by assessing the quality of programs and services and by acting on identified opportunities for improvement. Customer surveys are a common method to capture real-time information and data about the quality of programs and services from the viewpoint of those being served. If planned and executed carefully, customer surveys can capture customer feedback that can then be used to plan for improvements.

1. Conducting a Customer Satisfaction Survey

Measuring Customer Satisfaction: Nine Steps to Success is a resource developed by the Association of State and Territorial Health Officials (ASTHO) to help users prepare and implement surveys, then act on the results (ASTHO, 2014). The toolkit includes useful examples and an easy-to-use nine-step guide to conducting a survey from start to finish. The following summary lists ASTHO’s nine steps to success and provides examples of each step from Prentiss County (Mississippi) Health Department’s PHQIX submission titled "Prentiss County Customer Service Satisfaction Project."

9 Steps to Success

Background: Historically, Prentiss County has had low participation in the Women, Infants, and Children (WIC) program among eligible residents. This led a quality improvement (QI) team to consider root causes of the low participation numbers.

Step 1: Identify the Purpose of the Survey
The survey’s purpose was to examine factors related to client satisfaction in the Prentiss County WIC clinic and identify potential barriers to participation in the WIC program.

Step 2: Select a Program (or Set of Programs) and Identify Customers To Be Surveyed
The customers surveyed were WIC participants and clients.

Step 3: Determine How Results Will Be Used
The QI team planned to use results to gather data and help identify areas for improvement to promote overall client satisfaction and access to WIC program services.

Step 4: Determine Your Budget and Plan within It
This QI project was conducted as part of the National Network of Public Health Institutes Quality Improvement Award Program, an initiative that promoted shared learning by providing small grants ($5,000) to selected health departments to conduct a QI project designed to result in measurable change. In addition to the grant, individualized, distance-based coaching was part of the award.

Step 5: Identify People To Include in Survey Planning and Implementation
The WIC QI project team planned and implemented the survey. The QI team included a QI coordinator, chief nurse, district nutritionist, district administrator, warehouse clerk, and senior epidemiologist.

Step 6: Design the Survey
Survey questions were designed to examine clinic wait times and environment, staff attitudes toward clients, quality of care, client satisfaction, and client service practices in the WIC clinic from the perspective of WIC participants.

Step 7: Select Survey Administration Methods
A broad needs assessment survey was conducted during spring 2013. The two-page paper survey was administered in the clinic setting to as many WIC participants and clients as possible. A post-intervention client satisfaction survey was conducted 3 months after the start of the project.

Step 8: Pilot and Modify the Survey before Full-Scale Rollout
The QI project team indicated that this survey was based on surveys used elsewhere; presumably, the Prentiss County team did not pilot the survey before implementation.

Step 9: Analyze the Data, Report, and Follow Up
The pre-intervention survey revealed long lobby wait times, staff with poor attitudes, and disrespectful employees. Using quality tools and Plan, Do, Study, Act, the QI team provided training to WIC clerical staff to reduce wait times, to develop “courtesy phrases” for WIC clerical staff to use when clients visit the WIC clinic, and to reassign staff as needed. A follow-up satisfaction survey was conducted and revealed improvement in the percentage of clients who were satisfied during their visit to the clinic.

More information about Prentiss County’s QI project can be found at

2. Tips To Plan and Implement a Survey

Tip 1: Stay true to the overall purpose of the survey as you design the survey questions. If you are interested in conducting a survey to measure customer satisfaction, consider using these key topics listed in Measuring Customer Satisfaction: Nine Steps to Success:

  • Speed of service
  • Staff professionalism
  • Availability of staff, services, or products
  • Customer care
  • Product or service quality

Tip 2: Carefully consider the advantages and disadvantages of various survey distribution methods. Common distribution methods include direct mail, suggestion drop boxes, convenience sampling, or group administration. In Measuring Customer Satisfaction: Nine Steps to Success, ASTHO presents this summary of survey administrative methods.

MetricMail SurveysE-mail or Web-Based SurveysTelephone SurveysIn-Office Paper Surveys
Response rate Low Moderate High Moderate
Speed Slow Very fast Fast Very fast
Cost per completed survey Low Lowest High Low
Anonymity High Questionable None Questionable
Ability to clarify survey questions and responses None None High High
Administrative bias Limited Sample bias Interview bias Sample bias

Tip 3: Consider using free or inexpensive survey tools to collect and analyze survey data. Data collection and analysis can be time consuming. Tools like Survey Monkey, Qualtrics, or Google Forms can be invaluable as you gather and review completed surveys.

3. Customer Focus as an Agency Priority

High-performing public health departments have a strong customer focus. A customer-focused agency should possess an overall strategy for customer engagement, linked to its strategic plan, that answers the following questions:

  • How do we identify our customers?
  • How do we capture and analyze customer feedback?
  • How will we take action based on customer feedback?

Embracing Quality in Public Health: A Practitioner’s Quality Improvement Guidebook (Tews, Heany, Jones, VanDerMoere, & Madamala, 2012) encourages public health agencies to develop a strong customer focus, using customer input to improve public health programs and services.

4. Other Examples from PHQIX Submissions

These PHQIX submissions highlight the crossroads between customer satisfaction and QI in public health practice.

Examples from PHQIX

Allegan County (Michigan) Health Department (ACHD)
ACHD wanted to hear from its customers before making programmatic changes, but its staff knew that only 33% of health department programs used a standardized client satisfaction survey process. Using QI, ACHD increased the percentage of programs that offered a systematic client survey process, resulting in the availability of valuable feedback from clients, which has enabled ACHD to improve services to better meet community needs. The QI team sought to increase the percentage of ACHD’s programs that implement the department-wide survey process from 33% to 75% to give clients and stakeholders an opportunity for input. A total of 347 surveys were returned during the 4-month project period. As a result of this initiative, 90% of ACHD programs had surveys returned, and the percentage of all team members who adhered to the survey process increased from 33% to 81%.

Clackamas County (Oregon) Public Health Department (CCPHD)
During a 4-day Kaizen event, the team at CCPHD designed and implemented a division-wide customer feedback system. The aim of the project was to increase the number of client feedback forms (from 8 to 43 per month) submitted across all programs and services. The Clackamas County team also wanted clients to gain confidence in the customer feedback system and raise staff awareness about the process to solicit feedback from the individuals they serve. Although the project team did not achieve its target number of 43 completed feedback forms per month, they did almost triple the number of forms returned. The initial project raised staff awareness about customer satisfaction, and staff members continued to be engaged and committed to increasing the number of completed customer feedback forms, then acting on customer feedback recommendations. Additionally, staff and managers within the organization continue to review customer feedback to identify opportunities to make process improvements.

5. Resources

Association of State and Territorial Health Officials (ASTHO). (2014, April). Measuring customer satisfaction: Nine steps to success. Retrieved from

Tews, D. S., Heany, J., Jones, J., VanDerMoere, R., & Madamala, K. (2012, January). Customers, clients, and stakeholders. In Embracing quality in public health: A practitioner’s quality improvement guidebook (2nd ed.) (pp. 17–23). Retrieved from



Kane, T. Using Customer Satisfaction Surveys to Assess the Quality of Programs and Services. Sat, 05/20/2017. Available at Accessed 09/28/2021.



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Submitted by margyrob on

Thank you for this roadmap for developing new client satisfaction surveys.  We are assessing moving from a mailed survey to an electronic survey that will hopefully result in higher response rates from our population of low income people living with HIV.  The mailed surveys were also quite costly and time intensive. 

If any one has experience with making this kind of a change, please post what your challenges were and how you might have overcome them.  


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Margy Robinson MPH
HIV Care Services Mgr.
Multnomah County Health Dept.
Portland, OR

Submitted by tkane on

Greetings Margy - I'm glad you found the resources useful. ASTHO did an excellent job developing the toolkit. For additional input on your question (above), you can also post your question to the PHQIX Community Forum. -- Ty Kane 

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