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2025/2026 Rural Endoscopy (Dauphin, Neepawa, Swan River)

Client Experience Questionnaire

Tell us about your experience! Your feedback helps us to improve the way we provide care. This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness and Quality).

If the question does not apply, please leave blank.
What procedure did you have?
What location did you have your procedure at?
Prior to your procedure, did you have an appointment with the doctor who performed the procedure?
Dignity, Respect and Trust:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. I was treated with respect.
b. My privacy was respected as best it could be.
c. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
d. Before providing care, staff members introduced themselves to me, where appropriate.
e. In general, staff were compassionate.
Information Sharing:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a. Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.)
b. Staff talked to me about my health care options. (e.g. procedures/tests)
c. My healthcare provider used words I could understand.
d. I had the necessary information needed to make good decisions about my health.
e. The staff kept my information confidential and secure.
Participation:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a. Staff involved me or my family/support system in making decisions about my care.
b. I was encouraged to take part in my care as much as I was able.
c. My choices were respected.
d. I was comfortable expressing concerns about my care.
Accessibility and Responsiveness:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. My care was well coordinated.
b. I was cared for in a timely manner.
c. I had access to the care I needed.
d. My concerns were taken seriously.
e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey.
Quality:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a. I saw the health care provider(s) clean their hands before providing my care.
b. My identity was confirmed before receiving care. (e.g. asked my name, checked my wristband, asked my date of birth)
Quality:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy sidewalks, uneven surfaces, electrical cords, etc.).
d. I felt staff were up to date on the skills needed to provide my care.
e. Overall, I was satisfied with the quality of care I received.
Rural Endoscopy Program Specific Questions:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. I received a document explaining what the test involved.
b. I feel I received enough information to prepare for my test.
c. I understood all parts of having a sleeping/sedative injection for the test.
d. Before my procedure, I had an opportunity to ask my care team questions.
e. I was informed about what was happening to me.
f. While in hospital I was comfortable when waiting for the test.
g. I felt that staff tried to help me keep my dignity as much as possible.
h. I was given information on:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
1. How I will feel after my procedure
2. Receiving my test results
3. What to expect the first 24 hours following discharge.
Rural Endoscopy Program Specific Questions:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
i. Overall, I felt involved and able to participate with the care team as much as I wanted throughout my procedure (able to share concerns, ask questions, receive information to my questions, etc.)
j. Staff offered me pain relief and comfort.
k. Overall, how did you feel about the procedure?
(If question does not apply, leave blank)
Demographics: (of the patient)
Collected for statistical purposes only to target improvements.
Gender:
Ethnicity
Age:
Comments:
Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations: email patientrelations@pmh-mb.ca or
call 1-800-735-6596

Rural Endoscopy Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Rural Endoscopy patients or family members who might be interested in helping us review, design or provide feedback to our services.

If you would like more information or if you think you might be interested in becoming a Patient Partner, please click on the link below or contact Patient Relations by calling 1-800-735-6596.

https://prairiemountainhealth.ca/forms/patient-partner/
Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca

Thank you for your participation!