Objectives : To describe a process of quality improvement within a community child and adolescent psychology service by focusing upon areas of dissatisfaction as identified by parents.

Design : Follow-up study of parents who finished contact with the service during a specified period during 1993, 1995 and 1997.

Methods : The views of parents about the service were assessed by the Parent Satisfaction Questionnaire. This was posted to all families approximately 4 weeks after their last contact with the service. Non-respondents were followed-up by a researcher and the questionnaire completed. High rates of dissatisfaction were identified and quality improvement targets implemented.

Results : Levels of dissatisfaction as assessed by qualitative and quantitative data decreased over time.

Conclusion : The research design does not allow us to conclude that decreases in dissatisfaction were directly attributed to the changes implemented. Nonetheless, consumer satisfaction surveys can have an important role in ensuring and monitoring quality within mental health services although their traditional emphasis upon satisfaction is not helpful. Focusing upon dissatisfaction can inform service change with qualitative and quantitative data providing a way of assessing the impact of this change.