This study used data from four Kaiser Permanente Regions to examine the relations between employee opinions, customer opinions, and business performance. The preliminary questions we asked regarded whether facilities in which employees expressed more favorable work attitudes were also facilities which 1) had more satisfied members; 2) had better financial performance; 3) had more members; and 4) served more patients. Generally speaking, employee opinions were strongly and positively related to customer (member) opinions. More specifically: • Customer satisfaction is most related to employee opinions of doctors, organizational flexibility, and training for customer service. • Employee perceptions of doctors are very strongly related to customer perceptions. • Customer ability to see their provider is the customer’s window into the operational effectiveness of that location. • Service training is also strongly related to customer service perceptions in general, even the perceptions specifically about the physicians. Unfortunately, clear links were not found between either employee or customer opinions and business performance (eg, financial measures). We continue to examine these relationships, and others, in an attempt to further our understanding of these complex issues. We hope to report these results in future issues of The Permanente Journal. Note: These early findings represent a first step toward understanding the relationships between what employees think and how Kaiser Permanente performs. Future submissions to The Permanente Journal will report additional findings, including specific examination of the relation between employee opinions and the STAR Care Index as well as a companion article that provides the practical implications of this work, written by senior Human Resources executives within Kaiser Permanente.