Talking to customers about how your service can be improved can reap valuable rewards yet many firms seem reluctant to find out what their customers really think of them.

The finance director of a UK chain of private hospitals once explained the key to his group’s financial success: "We learned to ask smarter questions". His group’s biggest problem, of course, is that its major competitor is free. So the group knew from the start that its only hope of survival lay in service quality. But how to check on quality most effectively?

The FD said that his people routinely surveyed the views of every patient who came to any of the group’s 30 British hospitals. "We had pages of questionnaires on operations, staff, cleanliness and so on. The trouble was that although we could tell whether we were getting better or worse we could not tell why. And the numbers were not giving us any ideas about what we should do about it."

It took them two years, in his view, to learn to ask smarter questions. Three in particular:

• What did we do that you liked – any examples?

• What did we do that you did not like – any examples?

• If you were put in charge of this hospital tomorrow, what would you change?

The last of the three was especially valuable, because almost immediately the hospital started getting ideas for improvements that it would never have thought of itself.

For example, patients observed that the hospital’s corridors were rather bleak. "Wouldn’t it be nice", they said, "if we had a few bowls of flowers to brighten them up?" Cost to the hospital: negligible. Impact on the patients: huge.

Similarly, patients approved of the tea and coffee vending machines in each ward. But they noticed something else. "When I’m in my pyjamas and dressing gown, I’m not carrying any money", was how one man put it, "so my visitors have to buy their own drinks. I find it embarrassing. Wouldn’t it be nice if the drinks machines were free?" Again, the cost to the hospital was small, the value to patients huge.

Most professional service firms have close contact with clients. But few ask for a client’s views of the firm, much less go digging for examples and ideas.

Three reasons emerged – First, something that looks like a syllogism to do with "face". Experts have answers. Professionals are experts and cannot risk seeming not to have the answers by asking questions.

Second, an understandable but unhelpful inward focus. Especially in larger firms, staff tend to regard the partners as their primary clients. Junior partners are wary about the views of more senior partners. And senior partners tend to focus on sorting out internal turf issues. Real clients barely get a look-in, except via arm‘s-length general surveys of the "score 1-5" type.

Third, a widespread but unacknowledged gut-level fear. Professionals feel most comfortable when they feel in control. Asking questions in depth about quality – like discussing fees in detail – sets up a situation in which the client, for once, has more say than the professional. And in the dark recesses of most of our minds lurks a fear that whenever control passes out of our hands, rejection is in the air.

All three reasons are, of course, based on emotion, not rationality. The rational evidence points in the other direction, and the prizes are very large. Seminars which bring professionals and their own clients together informally can work well. Without exception, clients feel flattered by the attention and fascinated at the glimpse behind the professional veil. And far from being alarmed by any evidence of weakness among the professionals, they feel impressed that the firm is trying to improve its performance, not merely making advertising noises.

One professional services firm found direct commercial value in a client survey. "We talked in depth to 20 very senior clients and potential clients. All happily gave us up to three hours of their time, and between them came up with a number of ideas for our business that, frankly we would not have thought of ourselves. Indeed, we have launched a new nationwide rapid-reaction turnaround service in direct response to some of their ideas. Not surprisingly, it is going very well."

Not surprisingly, either, such surveys seem to be extremely rare. Very few clients recall any professional asking about their business – except as a transparent preamble to a pitch of some sort. Even fewer recall anyone taking a direct interest in the quality of the relationship.

There are no magic answers as to how the professions can get better at finding out what clients really think – how to get below bland surface impressions to map the undercurrents. But it tells us something rather disturbing about our much-touted incisive intellects and our ability to make tough decisions, that we can look at a course of action with so many upsides and no rational downsides - and turn away from it.

Perhaps the best tactic is to follow the advice of a thoughtful book by Susan Jeffers, an American therapist: "Feel the Fear – and Do It Anyway".