A regional Swedish hospital has been the site of a quality improvement program that focuses on patient satisfaction, staff work environment and quality of hospital services. This article describes the study component that measures patients' views of the quality of care. The purpose of this study was to develop a reliable and valid instrument, to determine the predictors of patients' ratings of quality and to measure patient satisfaction at two points in time to determine whether patient ratings change following a quality improvement initiative. The instrument developed in this study was designed to assess patients' perceptions of the quality of hospital services, staff work environment and overall satisfaction for the purpose of providing feedback to hospital staff. This information would be used for quality improvement efforts within the hospital. Unique to this instrument are questions regarding patients' perceptions of the hospital staff work environment. The results revealed that the questionnaire demonstrated valid and reliable properties. The significant predictors of quality ratings were information concerning one's illness, and perceptions of the staff work environment. Patient satisfaction was measured and then reassessed following the implementation of various department-based improvement programs. The reassessment revealed significantly higher patient ratings in most areas. An intrinsic aspect of this quality program was the engagement of, and feedback process to, hospital personnel. Questionnaire results were reported graphically to hospital management and staff, thus serving as a catalyst for improvement.