Inpatient Satisfaction Survey

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* 1. In which department were you admitted during your hospital stay?

Active Care Unit (Room 101 to 139)

Continuing Care Unit (Room 201 to 212)

Special Care Unit (Room 301 to 303)

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* 2. Please enter the date of your admission.

Date / Time

Date

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* 3. Were you admitted through the Emergency Department?

Yes

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* 4. Were you given enough information about what was going to happen during your admission to the hospital?

Not at all

Partly

Quite a bit

Completely

Your Care From Nurses

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* 5. During this stay at the hospital, how often did nurses treat you with courtesy and respect?

Never

Sometimes

Usually

Always

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* 6. During this stay at the hospital, how often did nurses explain things in a way you could understand?

Never

Sometimes

Usually

Always

Your Care From Doctors

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* 7. During this stay at the hospital, how often did doctors treat you with courtesy and respect?

Never

Sometimes

Usually

Always

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* 8. During this hospital stay, how often did doctors explain things in a way you could understand?

Never

Sometimes

Usually

Always

Your Experiences in this Hospital

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* 9. Do you feel that there was a good communication about your care between doctors, nurses and other hospital staff?

Never

Sometimes

Usually

Always

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* 10. Were you involved as much as you wanted to be in decisions about your care and treatment?

Never

Sometimes

Usually

Always

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* 11. Did staff check your identification band before giving you medicines, treatments, or tests?

Yes, always

Yes, sometimes

I do not remember

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* 12. How often did you get help in getting to the bathroom or in using a bedpan?

Never

Sometimes

Usually

Always

Not Applicable

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* 13. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

Never

Sometimes

Usually

Always

When you left The Hospital

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* 14. After you left the hospital, did you go directly to your own home, to someone else's home or to another health facility?

Own home

Someone else's home

Another health faciilty

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* 15. Did you receive enough information from hospital staff about your condition or treatment after you left the hospital?

Yes

Not Applicable

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* 16. Were you told what day you would likely be able to leave the hospital?

Yes, within the first two days, I was told what day I would likely be able to leave the hospital.

Yes, after the first two days, I was told what day I would likely be able to leave the hospital.

No, I was not told what day I would likely be able to leave the hospital.

Do not know / Do not remember / Not applicable

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* 17. Do you believe that this hospital takes your safety seriously?

Yes, definitely

No, somewhat

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* 18. Did you notice staff wash or disinfect their hands before caring for you?

Yes, always

Yes, sometimes

Never

I did not notice

I could not see any facilities for washing /disinfecting hands

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* 19. How would you rate the quality of the food (how it tasted, serving temperature, variety)?

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* 20. During this hospital stay, how often were your room and bathroom kept clean?

Never

Sometimes

Usually

Always

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* 21. The hospital staff took my cultural values and those of my family or caregiver into account.

Strongly agree

Agree

Disagree

Strongly disagree

Do not know / Do not remember / Not applicable

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* 22. Under the Official Languages Act, you have the right to be served in either English or French. Of these two languages, which is your preference?

English

French

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* 23. How often did you receive the service you needed in the official language (English or French) of your choice?

Never

Sometimes

Usually

Always

Overall Rating of Hospital

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* 24. Using any number between 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

Worst hospital possible
0

Best hospital possible
10

Worst hospital possible
0

Best hospital possible
10

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

Yes, definitely

Yes, probably

Inpatient Satisfaction Survey

Question Title

* 1. In which department were you admitted during your hospital stay?

Question Title

* 2. Please enter the date of your admission.

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* 3. Were you admitted through the Emergency Department?

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* 4. Were you given enough information about what was going to happen during your admission to the hospital?

Question Title

* 5. During this stay at the hospital, how often did nurses treat you with courtesy and respect?

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* 6. During this stay at the hospital, how often did nurses explain things in a way you could understand?

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* 7. During this stay at the hospital, how often did doctors treat you with courtesy and respect?

Question Title

* 8. During this hospital stay, how often did doctors explain things in a way you could understand?

Question Title

* 9. Do you feel that there was a good communication about your care between doctors, nurses and other hospital staff?

Question Title

* 10. Were you involved as much as you wanted to be in decisions about your care and treatment?

Question Title

* 11. Did staff check your identification band before giving you medicines, treatments, or tests?

Question Title

* 12. How often did you get help in getting to the bathroom or in using a bedpan?

Question Title

* 13. Before giving you any new medicine, how often did hospital staff tell you what the medicine was for?

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* 14. After you left the hospital, did you go directly to your own home, to someone else's home or to another health facility?

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* 15. Did you receive enough information from hospital staff about your condition or treatment after you left the hospital?

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* 16. Were you told what day you would likely be able to leave the hospital?

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* 17. Do you believe that this hospital takes your safety seriously?

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* 18. Did you notice staff wash or disinfect their hands before caring for you?

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* 19. How would you rate the quality of the food (how it tasted, serving temperature, variety)?

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* 20. During this hospital stay, how often were your room and bathroom kept clean?

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* 21. The hospital staff took my cultural values and those of my family or caregiver into account.

Question Title

* 22. Under the Official Languages Act, you have the right to be served in either English or French. Of these two languages, which is your preference?

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* 23. How often did you receive the service you needed in the official language (English or French) of your choice?

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* 24. Using any number between 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay?

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

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* 26. What can we do to improve our quality of service?

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* 27. Do you wish to be contacted regarding your comments?