JCI Standards for Clinical Care Program Certification, 4th Edition Field Review

1. Survey Participant Demographics

Question Title

* 1. How did you hear about this field review?

JCI Website

JCInsight Newsletter

Social Media

Account Executive

Colleague

Other (please specify)

Question Title

* 2. Which of the following best describes you?

JCI Field Staff Member (Consultant, Surveyor)

Representative from Health Care Organization

Representative from Professional Organization, Association, Society

JCI Central Office Staff Member

Other (please specify)

Question Title

* 3. Please identify your main role in the organization

Chief Executive Officer (CEO)

Accreditation Survey Coordinator

Senior Leadership (Chief Medical Officer, Chief Nursing Officer, Chief Operations Officer, or equivalent senior leadership position)

Leader of a clinical department or service

Leader of a non-clinical department or service

Medical staff member

Nursing staff member

Quality improvement or risk management director/leader

Quality improvement or risk management staff member

Academic Professor or Department Chair

Other (please specify)

Question Title

* 4. Which of the following best describes your organization?

Hospital

Hospital with Academic Medical Center

Ambulatory Care

Primary Care

Laboratory

Medical Transport

Long Term Care

Home Care

Other (please specify)

Question Title

* 5. Please identify which services are provided by your organization? (Check all that apply)

Hospital

Hospital with Academic Medical Center

Ambulatory Care

Primary Care

Laboratory

Medical Transport

Long Term Care

Other (please specify)

Question Title

* 6. In which geographic location is your organization located

Africa

Americas

Asia

Asia-Pacific

Caribbean

Europe

Middle East/Gult

Other (please specify)

Question Title

* 7. Please indicate your organization's accreditation status

Accredited by JCI

Not accredited by JCI

Prefer not to answer

Accredited by another accrediting organization (Please specify)