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). Question Title * 1. Tell Us About You Name & Title Facility Name Email Address Phone Number Question Title * 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. Question Title * 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) Question Title * 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 Question Title * 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...) Question Title * 6. Please share any additional comments you may have to improve the resource. Question Title * 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. Question Title Done