Purpose The purpose of this paper is to propose an innovative and integrated approach based on service quality measurement (SERVQUAL), quality function deployment (QFD) and failure modes and effects analysis (FMEA) for service quality improvement. Design/methodology/approach The SERVQUAL scale is used for service quality measurement, QFD is used for service design and FMEA is used to prevent possible failures during service delivery. Findings A case study in a public hospital in Turkey is performed to show how the proposed approach works in practice. The results of the study show that the proposed approach can be used effectively to assess service quality in practice. Originality/value Service quality has become an important issue for service enterprises facing a fiercely competitive environment to provide sustainability. This is the first study that applies an integrated methodology based on SERVQUAL scale, QFD and FMEA to service quality improvement.