This report describes the efforts of one surgical specialty medical practice to improve customer service and access for its patients. It specializes in liver disease and transplant surgery but, as a result of a merger with another specialty practice, it offers other types of surgery and care as well. Many of the patients who come to the specialty practice are quite ill and require extra patience and extra attention to ensure that their needs are met. Complaints from patients to their doctors indicated that the specialty practice had problems with customer service and "access;" that is, the ease with which patients can contact the practice, gain entry, and use the practice's services. The problems were confirmed by observations of patient-staff interactions, by performance data available from the medical center's systems, and by data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. The information presented in this report is based on interviews conducted with staff and management in the specialty practice and in various departments within the hospital and medical center. The first section offers brief background information and a short description of each of the steps in the six-step quality improvement process. The second section offers more detail about the organization and the six steps, and a big-picture look at lessons learned. An appendix lists training courses that were developed for staff and management.