Background: patient involvement in the design, planning and delivery of health services is acknowledged to be a local and national priority. Aims: to improve service quality through a quality improvement initiative to explore patient preferences for involvement in health services design, planning and delivery. Methods: a questionnaire was developed to: assess patient preferences for involvement in hospital service development; and explore differences in responses between patient subgroups. Findings: 162 patients were recruited. Most were positive about being engaged in all service developments, not just those used personally. Involvement through questionnaires with infrequent email communication was favoured over attendance at public meetings. Time was a greater barrier to being involved than distance or remuneration. Conclusion' Patients valued involvement in health service development, but finding free time during working hours was difficult. There were no differences in preferences for involvement between subgroups defined by gender, ethnicity, home situation or health.