Patient Satisfaction Survey

Dear Valued Patient,
The purpose of this survey is to help our hospital improve the service and care provided to our patients. The information you provide in this survey is private and confidential. We request that you please take the time to complete this survey thoughtfully. We thank you for participating in this important initiative.

About this Survey
This survey is about your overall experience at our hospital. It asks for your opinion about your most recent stay at our hospital. This information will be used to help improve services to all patients.

There are no right or wrong answers; it is your opinion that is important.
If you are assisting someone to complete this questionnaire, it is important that the patient's opinions are presented.
This survey is not the best way to make a formal complaint. If you would like to make a formal complaint about your experiences at our hospital, please notify your nurse.
Please note that the data extracted from this survey will be collated completely anonymously. Disclosure of identifiable information will be limited to senior management for follow up purposes.

Thank you again for taking the time to complete this survey and for choosing our hospital for your convalescent care.
Yours faithfully
The Hospital Team

*Compulsory codes *Staff will give you codes so this form is able to submit

Hospital code Survey code

Post survey(leave as no if you are completing this now)

Yes No

Todays date Day Month

Pre-admittance 1.1 Have you been a patient of our hospital prior to this admission?

Yes No Unsure N/A

1.2 Were you provided with information about your stay before you were admitted to our hospital?

Yes No Unsure N/A

1.3 Were you satisfied with the clarity of information you received about your upcoming admission?

Yes No Unsure N/A

1.4 Is there anything you would like to have known prior to your stay? If so please say..

1.5 Were your referred to our hospital by:

GP Surgeon Nurse at another hospital Other

Name of referrer:

1.6 How did you first hear about our hospital?

1.7 Who completed your admission form?

Me Other

If 'other', who completed the form?

Admittance Procedure During the admittance procedure, how would you rate the following:
2.1 Were you satisfied with the length of time your admittance took?

Poor Fair Good Very Good Excellent Unsure N/A

2.2 Was your room ready when you arrived?

Poor Fair Good Very Good Excellent Unsure N/A

2.3 When you were first admitted, were the staff friendly & helpful?

Poor Fair Good Very Good Excellent Unsure N/A

2.4 Were the hospital's routine and procedures (like meal times, visiting hours, doctors' visits etc) explained to you?

Poor Fair Good Very Good Excellent Unsure N/A

2.5 Was the hospital compendium helpful / informative?

Poor Fair Good Very Good Excellent Unsure N/A

Hospital Stay: a) Staff During your stay, how would you rate the following:
3.1 The courtesy of the nurses?

Poor Fair Good Very Good Excellent Unsure N/A

3.2 The responsiveness of the nurses to your needs?

Poor Fair Good Very Good Excellent Unsure N/A

3.3 The length of time nursing staff took to respond to your call?

Poor Fair Good Very Good Excellent Unsure N/A

3.4 The courtesy of the Doctors?

Poor Fair Good Very Good Excellent Unsure N/A

3.5 The helpfulness of our hospital staff in general?

Poor Fair Good Very Good Excellent Unsure N/A

3.6 The way staff explained procedures and instructions to you that you could understand?

Poor Fair Good Very Good Excellent Unsure N/A

3.7 The way the Doctor explained details about your procedures and medications that you could understand?

Poor Fair Good Very Good Excellent Unsure N/A

3.8 Did our hospital staff encourage your feedback?

Poor Fair Good Very Good Excellent Unsure N/A

Hospital Stay: b) Facilities During your stay, how would you rate the following:
3.9 The cleanliness of the toilets and showers?

Poor Fair Good Very Good Excellent Unsure N/A

3.10 The cleanliness of your room?

Poor Fair Good Very Good Excellent Unsure N/A

3.11 The cleanliness of common rooms where you spent most of your time?

Poor Fair Good Very Good Excellent Unsure N/A

3.12 The privacy of the room where you spent most time?

Poor Fair Good Very Good Excellent Unsure N/A

3.13 The comfort of your bed?

Poor Fair Good Very Good Excellent Unsure N/A

Hospital Stay: c) Care and Treatment During your stay, how would you rate the following:
3.14 How well information about your recovery/condition was explained to you?

Poor Fair Good Very Good Excellent Unsure N/A

3.15 The communication between doctors, nurses and other our hospital staff about your treatment?

Poor Fair Good Very Good Excellent Unsure N/A

3.16 The help you received for your pain?

Poor Fair Good Very Good Excellent Unsure N/A

3.17 The opportunity to ask questions about your condition or treatment?

Poor Fair Good Very Good Excellent Unsure N/A

3.18 The way staff involved you in decisions about your care?

Poor Fair Good Very Good Excellent Unsure N/A

3.19 The willingness of our hospital staff to listen to your health care problems?

Poor Fair Good Very Good Excellent Unsure N/A

3.20 How well our hospital staff responded to your health care problems?

Poor Fair Good Very Good Excellent Unsure N/A

3.21 How well the purposes of medicines were explained to you?

Poor Fair Good Very Good Excellent Unsure N/A

3.22 How well the possible side effects of medicines were explained to you?

Poor Fair Good Very Good Excellent Unsure N/A

Hospital Stay: d) Food During your stay, how would you rate the following:
3.23 The quality of the food overall?

Poor Fair Good Very Good Excellent Unsure N/A

3.24 The quantity of the food overall?

Poor Fair Good Very Good Excellent Unsure N/A

3.25 The Chef's ability to cater to your preferences?

Poor Fair Good Very Good Excellent Unsure N/A

Hospital Stay: e) Comfort/Environment During your stay, how would you rate the following:
3.26 The respect for your privacy during your stay?

Poor Fair Good Very Good Excellent Unsure N/A

3.27 Your personal safety?

Poor Fair Good Very Good Excellent Unsure N/A

3.28 How well your cultural or religious needs were respected by our hospital?

Poor Fair Good Very Good Excellent Unsure N/A

3.29 Being treated with respect?

Poor Fair Good Very Good Excellent Unsure N/A

Discharge | Post Discharge During the discharge procedure, how would you rate the following:
4.1 Length of time the discharge took and your comfort during that time?

Poor Fair Good Very Good Excellent Unsure N/A

4.2 The information you were given about how to manage your condition and recovery at home?

Poor Fair Good Very Good Excellent Unsure N/A

4.3 The arrangements made by our hospital for any services you needed when you got home?

Poor Fair Good Very Good Excellent Unsure N/A

4.4 The explanation (by our hospital staff) of the medicines you had to take after you left our hospital?

Poor Fair Good Very Good Excellent Unsure N/A

4.5 The explanation of what activities you should or should not do?

Poor Fair Good Very Good Excellent Unsure N/A

4.6 Were you provided with a medication profile on the medicines you had to take after you left our hospital?

Yes No Unsure N/A

4.7 Was a follow-up appointment made for you to see a doctor or as an outpatient?

Yes No Unsure N/A

4.8 Would you like a member of our hospital's medical team to contact you after a few days at home?

Yes No Unsure N/A

Grievences 5.1 Did you have reason to make a formal complaint during your stay?

Yes No Unsure N/A

5.2 Did you actually make a formal complaint during your stay?

Yes No Unsure N/A

5.3 Were you satisfied with the measures taken in response to your complaint?

Yes No Unsure N/A

Overall Hospital Experience 6.1 Thinking about all aspects of your stay at our hospital, how satisfied were you?

Poor Fair Good Very Good Excellent Unsure N/A

6.2 Was the length of time you spent at our hospital?

Too Long Too Short Just Right

6.3 What were the best things about your stay at our hospital?

6.4 What were the worst things about your stay at our hospital?

6.5 What could our hospital do to improve the care and services it provides to better meet the needs of patients?

6.6 Did any our hospital members exceed your expectations?

Yes No Unsure

If yes, how so?

6.7 Would you recommend our hospital to your friends / family?

Yes No Unsure

6.8 Do you have any comments?

Thank you for taking the time to complete this survey.