Community Perception Survey Question Title * 1. What is your gender? Female Male Other Choose Not To Identify OK Question Title * 2. What is your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older OK Question Title * 3. How many people currently live in your household? OK Question Title * 4. What is your approximate average household income? $0-$24,999 $25,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000 and up OK Question Title * 5. Have you ever received services at Mid-Valley Hospital? Yes No OK Question Title * 6. How would you describe your overall experience? Very Postive Positive Neutral Negative Very Negative Very Postive Positive Neutral Negative Very Negative Comments: OK Question Title * 7. How satisfied were you with the skill and competency of the staff at Mid-Valley Hospital? Extremely Satisfied Satisfied Neutral Dissatisfied Extremely Dissatisfied N/a Admitting Desk Staff Admitting Desk Staff Extremely Satisfied Admitting Desk Staff Satisfied Admitting Desk Staff Neutral Admitting Desk Staff Dissatisfied Admitting Desk Staff Extremely Dissatisfied Admitting Desk Staff N/a Housekeeping Staff Housekeeping Staff Extremely Satisfied Housekeeping Staff Satisfied Housekeeping Staff Neutral Housekeeping Staff Dissatisfied Housekeeping Staff Extremely Dissatisfied Housekeeping Staff N/a Food Services Staff Food Services Staff Extremely Satisfied Food Services Staff Satisfied Food Services Staff Neutral Food Services Staff Dissatisfied Food Services Staff Extremely Dissatisfied Food Services Staff N/a Nurses Nurses Extremely Satisfied Nurses Satisfied Nurses Neutral Nurses Dissatisfied Nurses Extremely Dissatisfied Nurses N/a Physicians Assistants Physicians Assistants Extremely Satisfied Physicians Assistants Satisfied Physicians Assistants Neutral Physicians Assistants Dissatisfied Physicians Assistants Extremely Dissatisfied Physicians Assistants N/a Radiology Technicians Radiology Technicians Extremely Satisfied Radiology Technicians Satisfied Radiology Technicians Neutral Radiology Technicians Dissatisfied Radiology Technicians Extremely Dissatisfied Radiology Technicians N/a Laboratory Technicians Laboratory Technicians Extremely Satisfied Laboratory Technicians Satisfied Laboratory Technicians Neutral Laboratory Technicians Dissatisfied Laboratory Technicians Extremely Dissatisfied Laboratory Technicians N/a Doctors Doctors Extremely Satisfied Doctors Satisfied Doctors Neutral Doctors Dissatisfied Doctors Extremely Dissatisfied Doctors N/a Surgeons Surgeons Extremely Satisfied Surgeons Satisfied Surgeons Neutral Surgeons Dissatisfied Surgeons Extremely Dissatisfied Surgeons N/a Comments: OK Question Title * 8. Have you ever received care at Mid-Valley Clinic? Yes No OK Question Title * 9. How would you describe your overall experience at Mid-Valley Clinic? Very Positive Positive Neutral Negative Very Negative N/A Cleanliness Cleanliness Very Positive Cleanliness Positive Cleanliness Neutral Cleanliness Negative Cleanliness Very Negative Cleanliness N/A Staff Friendliness Staff Friendliness Very Positive Staff Friendliness Positive Staff Friendliness Neutral Staff Friendliness Negative Staff Friendliness Very Negative Staff Friendliness N/A Competency of Medical Care Team Staff Competency of Medical Care Team Staff Very Positive Competency of Medical Care Team Staff Positive Competency of Medical Care Team Staff Neutral Competency of Medical Care Team Staff Negative Competency of Medical Care Team Staff Very Negative Competency of Medical Care Team Staff N/A Services Offered Services Offered Very Positive Services Offered Positive Services Offered Neutral Services Offered Negative Services Offered Very Negative Services Offered N/A OK Question Title * 10. Are you familiar with Mid-Valley Hospital's services? (Please check the box next to those that you are aware of) Emergency Care Dietary/ Nutrition Counseling Birthing Center Pharmacy Radiology Services (including MRI, CT Scans, Nuclear Medicine, X-Ray, Ultrasound, & Mammography) Respiratory Therapy General Surgery Inpatient Services (including, but not limited to Total joint reconstruction of the knee, hip and shoulder, Bowel Resections, Cesarean sections, Hysterectomies, Trauma Surgery) General Surgery Outpatient Services (including, but not limited to OB/GYN, Endoscopy, Ophthalamic, Colonoscopy, Hernia repair, Biopsies or mass removals, ACL reconstruction, hand & foot surgery, skin grafting) Swing Bed Unit OK Question Title * 11. Are you familiar with Mid-Valley Clinic's services? Primary Care Walk-In Care Pediatrics General Surgery Orthopedics (including total joint replacements) Sports Medicine Pain Management Mental & Behavioral Health Women's Health (OBGYN) X-Ray & Lab Services Wound Care Anticoagulation Clinic OK Question Title * 12. Are you familiar with Mid-Valley Hospital's Physical Therapy Services? (Please check the boxes next to the services you are aware of.) General Orthopedic Rehab (Total Joint, Post-Shoulder Sugery, Post-Spine Surgery, etc.) Neurological Rehab (Post-Stroke, Traumatic Brain Injury, etc) L&I Injury Speech Therapy Occupational Therapy Balance Deficits and General Deconditioning Chronic Pain Conditions Sports Injury/ Recovery Repetitive Stress Injury Ergonomic Assessment/ Needs Prosthetic Needs Assessments Wheelchair Needs Assessments Vestibular Assessment/ Rehab Hand Therapy OK Question Title * 13. Why do you choose Mid-Valley Hospital & Clinic? (Please choose your number one reason) The medical staff is skilled, professional, and competent. The support staff is friendly and helpful. The overall quality of care is good. It is convenient to where I live. My employer or insurance directs me. I do not choose Mid-Valley Hospital & Clinic. OK Question Title * 14. If you choose to seek care out of town, why do you do so? (Please check all that apply.) I perceive other hospitals/ clinics are better. I perceive that larger, more urban hospitals have more technologically advanced care. I perceive that I can get better specialty care elsewhere. My doctor refers me to a different hospital or clinic. My employer or insurance directs me. N/a OK Question Title * 15. If you have chosen to seek care out of town, for which services have you gone elsewhere? General Surgery Orthopedic Services/ Surgery Sports Medicine Primary Care Outpatient Services/ Surgery Other I have not sought care out of town. If other, please specify: OK Question Title * 16. If you choose to seek Primary Care elsewhere, where do you go? Confluence Health Family Health Center Other Choose Not To Answer OK Question Title * 17. What is your perception of Mid-Valley Hospital & Clinic's reputation in the community? Please answer even if you have not received services from us. Extremely Positive Positive Not Positive or Negative Negative Extremely Negative Extremely Positive Positive Not Positive or Negative Negative Extremely Negative Comments: OK Question Title * 18. If a local healthcare provider wanted to communicate information about any updates to services and programs to you, what would be your most preferred method of receiving that information? (Please check all that apply) Direct Mail Newspapers/ Magazines Radio Email Web/Internet Social Media Billboards Brochures I am not interested in getting any news or service updates from my local healthcare providers. OK Question Title * 19. At Mid-Valley Hospital & Clinic, our goal is to continually improve our services and patient care. We value your opinion. Do you have any comments, praise or suggestions to share with the Mid-Valley staff? OK Question Title * 20. What is your zipcode? OK Question Title * 21. Would you be interested in being a part of a newly formed Patient & Family Advisory Council? Yes No If you clicked "yes" and would like to share your contact information here, please enter it in this field. If you would like to keep your survey results anonymous but are interested in participating in the Patient & Family Advisory Council, please reach out to our new Director of Marketing & PR, Mikaela Marion at marionm@mvhealth.org or at 509-861-2500. OK DONE
