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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
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.)
Day surgery environment
4.In your opinion, how clean was the day surgery area?(Required.)
Seeing a surgeon
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.)
Overall about your procedure
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.)
Leaving the hospital
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.)
Overall impression
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.)
1
5
10
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.)
About you
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?