An important factor to emerge from this internal/external comparison, is that the quality of service given to patients is totally dependent on the quality of service provided within the internal customer/supplier linkage. This vital element is generally referred to as the quality chain (see Figure 3). This therefore means that "patient first" attitudes must be applied, and accepted, with equal vigour, both inside and outside the hospital (see Figure 4). Two internal rules must, however, apply:
(1) As an internal "supplier", you must agree and fully satisfy the needs of your "customer".
(2) As an internal "customer", you must establish your requirements, unambiguously, with your "supplier".