NOSH Ontario Day Surgery Experience Survey

♦ You should fill out this questionnaire only if you were the patient. You may need to get help from a family member or friend to answer the questions. That’s okay.

♦ Answer all the questions by checking the box to the left of your answer.

♦ Your response to this survey is voluntary but will provide us with important information.

♦ You are sometimes told to skip over some questions in this survey. When this happens, you will see an arrow with a note that tells you what question to answer next, like this:

Before your procedure

Question Title

1. Was this your first visit as a patient to the North of Superior Healthcare Group? (Required.)

Yes

Question Title

2. Before your procedure, did a health professional explain what would happen to you, in a way you could understand? (Required.)

Definitely

For the most part

Somewhat

Not at all

Don't know/Can't remember

I did not want an explanation

Question Title

3. Before your procedure, did a health professional explain any risks and/or benefits in a way you could understand? (Required.)

Definitely

For the most part

Somewhat

Not at all

Don't know/Can't remember

I did not want an explanation

Day surgery environment

Question Title

4. In your opinion, how clean was the day surgery area? (Required.)

Very clean

Fairly clean

Not very clean

Not at all clean

Can’t say

Seeing a surgeon

Question Title

5. Before your procedure, either on the day of your surgery or in a pre-operation appointment, did you have enough time to talk about your health or medical problem with the surgeon? (Required.)

Definitely

For the most part

Somewhat

Not at all

Don’t know / Can’t remember

Question Title

6. Before your procedure, did the surgeon listen carefully to what you had to say? (Required.)

Definitely

For the most part

Somewhat

Not at all

Don’t know / Can’t remember

Question Title

7. Before your procedure, if you had questions to ask the surgeon, did you get answers that you could understand? (Required.)

Definitely

For the most part

Somewhat

Not at all

I did not need to ask

I did not have an opportunity to ask

Question Title

8. Did you have confidence and trust in the surgeon examining and treating you? (Required.)

Definitely

For the most part

Somewhat

Not at all

Question Title

9. If you had any worries or fears about your condition or treatment, did a surgeon talk with you about them? (Required.)

Definitely

For the most part

Somewhat

Not at all

Overall about your procedure

Question Title

10. Did the health professionals treating and examining you introduce themselves? (Required.)

Yes, all of the staff introduced themselves

Some of the staff introduced themselves

Very few or none of the staff introduced themselves

Don’t know / Can’t remember

Question Title

11. Were you given enough privacy when discussing your condition or procedure? (Required.)

Definitely

For the most part

Somewhat

Not at all (please tell us more)

Question Title

12. How often, during your most recent day surgery experience, were you involved as much as you wanted to be in decisions about your care and treatment? (Required.)

Always

Usually

Sometimes

Never

Leaving the hospital

Question Title

13. Before you left the hospital, were you told what would happen next (for example, did you need another appointment, did you need to see your family doctor)? (Required.)

Definitely

For the most part

Somewhat

Not at all

Don't know/Can't remember

Question Title

14. Did you receive enough information from health professionals about what to do if you were worried about your condition or treatment after you left the hospital? (Required.)

Definitely

For the most part

Somewhat

Not at all

Overall impression

Question Title

15. Overall, did you feel you were treated with respect and dignity while you were at the hospital? (Required.)

Definitely

For the most part

Somewhat

Not at all

Question Title

16. Overall how would you rate the care you received during this visit? 1 being you had a very poor experience and 10 being you had a very good experience. (Required.)

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

17. Would you recommend this hospital to your friends and family? (Required.)

Definitely yes

Probably yes

Probably no

Definitely no

Question Title

18. During the visit, were you respected and your preferences considered regarding your treatment and care plan? (Required.)

Yes, definitely

Yes, somewhat

Question Title

19. During this visit, did you have enough say about your treatment? (Required.)

Yes, definitely

Yes, somewhat

Question Title

20. In general, how would you rate your overall physical health? (Required.)

Excellent

Very good

Good

Fair

Poor

Question Title

21. In general, how would you rate your overall mental or emotional health? (Required.)

Excellent

Very good

Good

Fair

Poor

Question Title

22. What is the highest grade or level of school that you have completed? (Required.)

8th grade or less

Some high school, but did not graduate

High school or high school equivalency certificate

College, CEGEP or other non-university certificate or diploma

Undergraduate degree or some university

Post-graduate degree or professional designation

Question Title

23. What is your gender? (Required.)

Male

Female

Other

Question Title

24. What is your year of birth?
(Please write in; for example, “1934.”) (Required.)

Question Title

25. The following question will help us to better understand the communities that we serve. Do you consider yourself to be . . . (Check all that apply) (Required.)

White

Chinese

First Nation

Inuit

Métis

Indigenous/Aboriginal (not included elsewhere)

South Asian (East Indian, Pakistani, Sri Lankan, etc.)

Black

Filipino

Latin American

Southeast Asian (Vietnamese, Cambodian, Malaysian, Laotian, etc.)

Arab

West Asian (Iranian, Afghan, etc.)

Korean

Japanese

Other (please specify)

Question Title

26. What is your mother tongue? (Required.)

English

French

Other

Other (please specify)

NOSH Ontario Day Surgery Experience Survey

Question Title

Question Title

* 1. Was this your first visit as a patient to the North of Superior Healthcare Group? (Required.)

Question Title

* 2. Before your procedure, did a health professional explain what would happen to you, in a way you could understand? (Required.)

Question Title

* 3. Before your procedure, did a health professional explain any risks and/or benefits in a way you could understand? (Required.)

Question Title

* 4. In your opinion, how clean was the day surgery area? (Required.)

Question Title

* 5. Before your procedure, either on the day of your surgery or in a pre-operation appointment, did you have enough time to talk about your health or medical problem with the surgeon? (Required.)

Question Title

* 6. Before your procedure, did the surgeon listen carefully to what you had to say? (Required.)

Question Title

* 7. Before your procedure, if you had questions to ask the surgeon, did you get answers that you could understand? (Required.)

Question Title

* 8. Did you have confidence and trust in the surgeon examining and treating you? (Required.)

Question Title

* 9. If you had any worries or fears about your condition or treatment, did a surgeon talk with you about them? (Required.)

Question Title

* 10. Did the health professionals treating and examining you introduce themselves? (Required.)

Question Title

* 11. Were you given enough privacy when discussing your condition or procedure? (Required.)

Question Title

* 12. How often, during your most recent day surgery experience, were you involved as much as you wanted to be in decisions about your care and treatment? (Required.)

Question Title

* 13. Before you left the hospital, were you told what would happen next (for example, did you need another appointment, did you need to see your family doctor)? (Required.)

Question Title

* 14. Did you receive enough information from health professionals about what to do if you were worried about your condition or treatment after you left the hospital? (Required.)

Question Title

* 15. Overall, did you feel you were treated with respect and dignity while you were at the hospital? (Required.)

Question Title

* 16. Overall how would you rate the care you received during this visit? 1 being you had a very poor experience and 10 being you had a very good experience. (Required.)

Question Title

* 17. Would you recommend this hospital to your friends and family? (Required.)

Question Title

* 18. During the visit, were you respected and your preferences considered regarding your treatment and care plan? (Required.)

Question Title

* 19. During this visit, did you have enough say about your treatment? (Required.)

Question Title

* 20. In general, how would you rate your overall physical health? (Required.)

Question Title

* 21. In general, how would you rate your overall mental or emotional health? (Required.)

Question Title

* 22. What is the highest grade or level of school that you have completed? (Required.)

Question Title

* 23. What is your gender? (Required.)

Question Title

* 24. What is your year of birth?(Please write in; for example, “1934.”) (Required.)

Question Title

* 25. The following question will help us to better understand the communities that we serve. Do you consider yourself to be . . . (Check all that apply) (Required.)

Question Title

* 26. What is your mother tongue? (Required.)

Question Title

* 27. Is there anything else you would like to share about your visit to the North of Superior Healthcare Group?

1. Was this your first visit as a patient to the North of Superior Healthcare Group? (Required.)

2. Before your procedure, did a health professional explain what would happen to you, in a way you could understand? (Required.)

3. Before your procedure, did a health professional explain any risks and/or benefits in a way you could understand? (Required.)

4. In your opinion, how clean was the day surgery area? (Required.)

5. Before your procedure, either on the day of your surgery or in a pre-operation appointment, did you have enough time to talk about your health or medical problem with the surgeon? (Required.)

6. Before your procedure, did the surgeon listen carefully to what you had to say? (Required.)

7. Before your procedure, if you had questions to ask the surgeon, did you get answers that you could understand? (Required.)

8. Did you have confidence and trust in the surgeon examining and treating you? (Required.)

9. If you had any worries or fears about your condition or treatment, did a surgeon talk with you about them? (Required.)

10. Did the health professionals treating and examining you introduce themselves? (Required.)

11. Were you given enough privacy when discussing your condition or procedure? (Required.)

12. How often, during your most recent day surgery experience, were you involved as much as you wanted to be in decisions about your care and treatment? (Required.)

13. Before you left the hospital, were you told what would happen next (for example, did you need another appointment, did you need to see your family doctor)? (Required.)

14. Did you receive enough information from health professionals about what to do if you were worried about your condition or treatment after you left the hospital? (Required.)

15. Overall, did you feel you were treated with respect and dignity while you were at the hospital? (Required.)

16. Overall how would you rate the care you received during this visit? 1 being you had a very poor experience and 10 being you had a very good experience. (Required.)

17. Would you recommend this hospital to your friends and family? (Required.)

18. During the visit, were you respected and your preferences considered regarding your treatment and care plan? (Required.)

19. During this visit, did you have enough say about your treatment? (Required.)

20. In general, how would you rate your overall physical health? (Required.)

21. In general, how would you rate your overall mental or emotional health? (Required.)

22. What is the highest grade or level of school that you have completed? (Required.)

23. What is your gender? (Required.)

24. What is your year of birth?
(Please write in; for example, “1934.”) (Required.)

25. The following question will help us to better understand the communities that we serve. Do you consider yourself to be . . . (Check all that apply) (Required.)

26. What is your mother tongue? (Required.)

27. Is there anything else you would like to share about your visit to the North of Superior Healthcare Group?