Please remember, this questionnaire is about your most recent procedure. Please think only about your most recent visit.
Before your procedure

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

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

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* 3. Before your procedure, did your doctor or anyone from the hospital give you easy to understand instructions about getting ready for your procedure?

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

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* 5. Before your procedure, did you know who to contact if your symptoms or condition got worse?

Waiting for your procedure

Answer your questions 6 and 7 by still thinking about your most recent procedure.

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* 6. If your procedure did not start on time, how many minutes did you have to wait in the waiting room?

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* 7. If you had to wait, were you told why?

Day surgery environment

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* 8. In your opinion, how clean was the day surgery area?

Seeing a surgeon

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* 9. 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?

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* 10. Before your procedure, did the surgeon seem to know your medical history?

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* 11. Before your procedure, did the surgeon listen carefully to what you had to say?

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

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* 13. Did you have confidence and trust in the surgeon examining and treating you?

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

Overall about your procedure

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* 15. Did the health professionals treating and examining you introduce themselves?

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* 16. How much information about your condition or procedure was given to your family, caregiver or someone close to you?

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* 17. Were you given enough privacy when discussing your condition or procedure?

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* 18. Sometimes during an appointment, a health professional may say one thing and another may say something quite different. How often, during your most recent day surgery experience, did this happen to you?

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* 19. 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?

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* 20. Do you think the staff did everything they could to help control your pain?

Leaving the hospital

Medications (such as pills, tables, ointments)

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* 21. Before you left the hospital, did you have a clear understanding about
all of your prescribed medications, including those you were taking before your visit to the hospital?

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* 22. Did a health professional explain to you how to take your medications?

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* 23. Did a health professional explain why you need to take the medications?

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* 24. Did a health professional tell you about medication side effects to watch for?

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* 25. Do you think the staff did everything they could to prepare you to manage your pain after you left the hospital?

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* 26. 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)?

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* 27. Did you receive information about what symptoms or health problems regarding your illness or procedure to watch for at home?

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* 28. 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?

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* 29. Did doctors, nurses, or other health professionals talk to you about whether you would have the help you needed at home after you left the hospital?

Overall impression

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* 30. Was the main reason you went to the hospital dealt with to your satisfaction?

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* 31. Overall, did you feel you were treated with respect and dignity while you were at the hospital?

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* 32. 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.

1 5 10
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i We adjusted the number you entered based on the slider’s scale.

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* 33. Would you recommend this hospital to your friends and family?

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* 34. During the visit, were you respected and your preferences considered regarding your treatment and care plan?

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* 35. During this visit, did you have enough say about your treatment?

Care transitions

We know your experience as a patient begins before you arrive at the hospital and continues after you leave to go home. These next few questions ask about your experience transitioning into and out of the hospital.

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* 36. Thinking about all the health professionals you saw related to this procedure (including those you saw before and after the procedure), did you feel your care was well coordinated?

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* 37. Thinking about those same health professionals, did you feel like they worked well together towards the same treatment goal?

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* 38. Thinking about your overall experience related to this day surgery, to what extent did you experience smooth transitions between the hospital and other locations or health professionals?

About you

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* 39. In general, how would you rate your overall physical health?

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* 40. In general, how would you rate your overall mental or emotional health?

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* 41. What is the highest grade or level of school that you have completed?

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

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

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* 44. What is your mother tongue?

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* 45. If your mother tongue is neither English nor French, in which of Canada’s official languages are you most comfortable?

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* 46. Did you have access to someone who could explain what you needed to know about your care in a language in which you are comfortable?

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

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