CFWA PCH HiTH Service Survey (Jan - June 2020)

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* 1. How many times was your child transferred to Hospital in The Home (HiTH) in the past 6 month period?

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* 2. Which home care worker/s provided you HiTH service in the last six months? (tick all that apply)

Frances Kwiatkowski

Sharon Alaga

Kate Korosec

Sophie Maffey

Heather Riley

Hayley Fullarton

Josephine Palladino

Martin Carroll

Jessica O'Neill

Shannen King

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* 3. Please rate the HiTH service according to the following criteria:

	Poor	Average	Good	Excellent
Reliability (always punctual and rarely cancels)	Reliability (always punctual and rarely cancels) Poor	Reliability (always punctual and rarely cancels) Average	Reliability (always punctual and rarely cancels) Good	Reliability (always punctual and rarely cancels) Excellent
Friendliness of HCW	Friendliness of HCW Poor	Friendliness of HCW Average	Friendliness of HCW Good	Friendliness of HCW Excellent
Professionalism (shows respect, empathy and integrity)	Professionalism (shows respect, empathy and integrity) Poor	Professionalism (shows respect, empathy and integrity) Average	Professionalism (shows respect, empathy and integrity) Good	Professionalism (shows respect, empathy and integrity) Excellent
Competency (understands of my child’s treatment routine)	Competency (understands of my child’s treatment routine) Poor	Competency (understands of my child’s treatment routine) Average	Competency (understands of my child’s treatment routine) Good	Competency (understands of my child’s treatment routine) Excellent
Infection Control (wears gown and performs hand hygiene appropriately)	Infection Control (wears gown and performs hand hygiene appropriately) Poor	Infection Control (wears gown and performs hand hygiene appropriately) Average	Infection Control (wears gown and performs hand hygiene appropriately) Good	Infection Control (wears gown and performs hand hygiene appropriately) Excellent
Flexibility with appointment times	Flexibility with appointment times Poor	Flexibility with appointment times Average	Flexibility with appointment times Good	Flexibility with appointment times Excellent

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* 4. Would you consider continuing with these services or using HiTH again in the future?

Yes

No

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* 5. How do you rate the value of the joint visit with CFWA HCW and PCH Physio? (Please ignore this question if you did not have a joint visit)

Poor

Average

Good

Excellent

Poor

Average

Good

Excellent

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* 6. Please provide any additional comments/suggestions for this service: