2018 Evaluation of Network Council Meeting and Overall Customer Satisfaction

Part One: Tell Us How We're Doing

Heartland Kidney Network (HKN) is interested in your opinions and comments regarding the operations of our office and the services we offer. As a quality focused organization, your evaluation of us is of great importance. Please take a few minutes to complete this questionnaire. The information provided will be used for monitoring and improving our services. We ask that you submit your feedback no later than July 31, 2018.

Question Title

* 1. I am a ... (select your role/discipline ... check all that apply)

Physician

Nurse

Social Worker

Dietitian

Technician

Patient

Medical Director

Unit Administrator

Corporate / Regional Manager

Administrative Assistant / Secretary

Other (please specify)

Question Title

* 2. Have you contacted the Network in the past 12 months? If so, what was the reason? (Check all that apply)

Patient grievance or patient issue

Looking for a resource

Reporting an emergency situation at your clinic (closing, schedule changes due to weather or other disaster related emergency)

Ordering materials from the Network (posters, My Kidney Kit, My Kidney Calendar, Cannulation Arm, etc.)

CROWNWeb support or data issue

Questions about ESRD QIP, Dialysis Data.org, Dialysis Facility Compare

Questions about a Quality Improvement Activity (QIA)

Question about Providers.Exchange

Other (please specify)

Question Title

* 3. When I contact the Network by phone or email,

	Always	Most of the Time	Some of the Time	Never	Does Not Apply
I am answered promptly.	I am answered promptly. Always	I am answered promptly. Most of the Time	I am answered promptly. Some of the Time	I am answered promptly. Never	I am answered promptly. Does Not Apply
the staff is courteous and polite.	the staff is courteous and polite. Always	the staff is courteous and polite. Most of the Time	the staff is courteous and polite. Some of the Time	the staff is courteous and polite. Never	the staff is courteous and polite. Does Not Apply
their response is timely.	their response is timely. Always	their response is timely. Most of the Time	their response is timely. Some of the Time	their response is timely. Never	their response is timely. Does Not Apply

Please provide any specific feedback that you have regarding contacting the Network

Question Title

* 4. In the past 12 months, have you:

Accessed the website at www.heartlandkindey.org (The website was redesigned in July 2018, check it out!)

Accessed the Facebook page at www.facebook.com/heartlandkidney

Accessed Providers.Exchange

Utilized the My Kidney Kit

Utilized the My Kidney Calendar

Question Title

* 5. Do you currently receive the Heartland Happenings, monthly eNewsletter from the Network? If so do you feel the content is informative and worth your time to read?

True

False

Comments

Question Title

* 6. How likely are you to contact the Network?

Very likely

Somewhat likely

Not likely at all

Very likely

Somewhat likely

Not likely at all

If not likely, please specify why

Question Title

* 7. How likely are you to refer a patient to the Network? (This could be for resources, information about being a Network Patient Representative or a Patient Advisory Council member, being involved on a national CMS Learning and Action Network (LAN) call, etc.)

Very likely

Somewhat likely

Not likely at all

Very likely

Somewhat likely

Not likely at all

If not likely, please specify why

Question Title

Question Title

* 1. I am a ... (select your role/discipline ... check all that apply)

Question Title

* 2. Have you contacted the Network in the past 12 months? If so, what was the reason? (Check all that apply)

Question Title

* 3. When I contact the Network by phone or email,

Question Title

* 4. In the past 12 months, have you:

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* 5. Do you currently receive the Heartland Happenings, monthly eNewsletter from the Network? If so do you feel the content is informative and worth your time to read?

Question Title

* 6. How likely are you to contact the Network?

Question Title

* 7. How likely are you to refer a patient to the Network? (This could be for resources, information about being a Network Patient Representative or a Patient Advisory Council member, being involved on a national CMS Learning and Action Network (LAN) call, etc.)

Question Title

* 8. Feel free to use this space to share a suggestion for how HKN can improve or share a successful interaction with the Network.