Heartland Huddle Up to Improve Care
Resource Evaluation

Thank you for taking the time to complete this evaluation of the Heartland Huddle Up to Improve Care concept sheets. These concept sheets have been developed to provide a quick review with facility staff. Your feedback is important to the Network as we work to continually improve the resources we develop and provide to the Network community. If you are assessing more than one huddle sheet or series, please enter a separate evaluation for each topic addressed. A new evaluation screen will be available once you select DONE (i.e. it will loop back to blank form).

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* 1. Tell Us About You

Name & Title

Facility Name

Email Address

Phone Number

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* 2. Facility MEDICARE Number (6 digit number beginning with 16 -Iowa, 17 -Kansas, 26 -Missouri, 28 -Nebraska) Please do not enter a corporate ID Number.

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* 3. Please indicate the Heartland Huddle to Improve Care concept sheet you are evaluating. (Mark all that apply if you would prefer to evaluate a series as a group. For example: Communication, Shared Decision Making or Grievances)

Communication: Active Listening

Communication: Body Language

Communication: Emotional Awareness

Communication: Words Matter

Communication: Show Respect

What type of Coach are You?

Teach-Back

Shared Decision Making (OVERVIEW)

Shared Decision Making (PROCESS)

Shared Decision Making (CASE EXAMPLE)

Grievances: Definition

Grievances: Process

Grievance: Retaliation

Five Minute Patient Quality Improvement Huddle

Other: (Please specify)

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* 4. Please rate the following elements for the resource.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Content was appropriate.	Content was appropriate. Strongly Agree	Content was appropriate. Agree	Content was appropriate. Neutral	Content was appropriate. Disagree	Content was appropriate. Strongly Disagree
Information was helpful.	Information was helpful. Strongly Agree	Information was helpful. Agree	Information was helpful. Neutral	Information was helpful. Disagree	Information was helpful. Strongly Disagree
Visually appealing.	Visually appealing. Strongly Agree	Visually appealing. Agree	Visually appealing. Neutral	Visually appealing. Disagree	Visually appealing. Strongly Disagree
Length was appropriate.	Length was appropriate. Strongly Agree	Length was appropriate. Agree	Length was appropriate. Neutral	Length was appropriate. Disagree	Length was appropriate. Strongly Disagree
I am more confident with my understanding of the topic after reviewing the resource.	I am more confident with my understanding of the topic after reviewing the resource. Strongly Agree	I am more confident with my understanding of the topic after reviewing the resource. Agree	I am more confident with my understanding of the topic after reviewing the resource. Neutral	I am more confident with my understanding of the topic after reviewing the resource. Disagree	I am more confident with my understanding of the topic after reviewing the resource. Strongly Disagree
I would recommend this resource to a colleague.	I would recommend this resource to a colleague. Strongly Agree	I would recommend this resource to a colleague. Agree	I would recommend this resource to a colleague. Neutral	I would recommend this resource to a colleague. Disagree	I would recommend this resource to a colleague. Strongly Disagree

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* 5. After using this resource, I HAVE or WILL complete the following actions.

Implement(ed) a change based on the information provided. (Please specify in comments.)

Use(d) the resource to educate staff during a team huddle or staff meeting.

Use(d) the resource with patients.

Post(ed) a copy of the resource.

Review(ed) the facility policy and procedure.

Review(ed) additional information on the topic.

Other or Additional Comments (For example: We will include Huddles in our staff training every...)

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* 6. Please share any additional comments you may have to improve the resource.

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* 7. What other topics would you like resources on?

Thank you for taking the time to complete this assessment, your feedback will help the Network to evaluate our resources and make improvements.