This Article Has Been Medically Approved By

Dr. George H. Sanders

This may seem like a silly question, “But what do patients want when it comes to quality?” Do they want an operation that is performed well or do they want to have the service delivered in a pleasing way? The measurement of how well the operation is performed is called “Technical Quality” and the way it is delivered is called “Functional Quality.” Do patients want Technical Quality or do they desire Functional Quality? An interesting article from the Aesthetic Surgery Journal of August 2012 authored by Thomas Fiala, M.D., points out that when it comes to quality, surgeons and patients measure things in radically different ways.

Research has shown that surgeons emphasize Technical Quality (TQ). It is their technical skills that “save the day” and make patients happy. Performing an operation correctly, in a timely manner, and without complication or the need for reoperation represents quality according to most surgeons.


On the other hand, research has shown that Functional Quality (FQ) is the single most important factor used by consumers to form judgments about the quality of the delivered service. They don’t have as much knowledge about the technical aspects of the service. In fact, when patients are asked to make a judgment about the TQ of a physician, they substitute value judgments derived from FQ issues – whether the receptionist greeted them cheerfully, how long they had to wait to see the doctor, whether the doctor was nice to his staff, etc – to infer an answer about TQ. In other words, if FQ seems good, the TQ of the doctor must be good!


This same type of thing occurs when consumers choose airlines. Ask yourself, is your perception of the quality of the airline based on how many accident-free miles the airline has flown (TQ) or is it based on the quality of the in-flight service, friendliness of the ticket agent, and overall convenience (FQ)? If you’re like most people, FQ is the major determinant! You reason, they’re all equally safe so let’s focus on the pleasantness of the experience.

In reality, however, overall quality is the sum of technical and functional quality:


Surgeons need to strive for excellence in both regards. Do the procedure with excellence, but also deliver care with empathy, compassion, and with good communication. If a surgeon does not excel in these latter three areas, additional training is available and improvement is possible. To assist in the delivery of high FQ care, the surgeon should hire personnel that are service-minded, and the surgeon should continually train and emphasize these qualities in their staff members.

My personal experience has been that most of my patients appreciate both TQ and FQ. Most of today’s plastic surgery consumers have been well educated by the Internet and conversations with other patients. They appreciate TQ and expect FQ. For them, OVERALL QUALITY = TECHNICAL QUALITY + FUNCTIONAL QUALITY. My solution: I seek to maximize both TQ and FQ!!

Should you have any further questions, please contact my office.

George Sanders, M.D.