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Inpatient Client Experience Survey
1.
Did you feel that you were treated with compassion and respect during your hospital visit?
Yes, always
Yes, Sometimes
No
If no, please tell us what we can improve.
2.
Did staff introduce themselves to you before providing care?
Yes, always
Yes, Sometimes
No
3.
Did staff take your cultural values, or personal preferences, and those of your family or caregiver into account when making decisions about your care?
These things may include, but are not limited to, accessibility needs, interpreter assistance, visits by clergy, elders, or spiritual leaders.
Yes, always
Usually
Sometimes
Never
If never, please tell us what we can do better.
4.
Did staff explain your condition and treatment in a way you could understand?
Yes, always
Yes, sometimes
No
5.
Were you satisfied that you were invloved as much as you wanted to be in decision making about your care or treatment?
Yes, always
Yes, sometimes
No
If no, please tell us what we can improve.
6.
When you had pain during this hospital stay, was it mild, moderate, or severe?
No Pain
MIld Pain
Moderate Pain
Severe Pain
7.
Did you feel you were treated in a way that was helpful and supportive to you?
Yes, always
Yes, sometimes
No
If no, please tell us what we can improve.
8.
Were you satisfied with the quality of food you received?
Yes, always
Yes, sometimes
No
If no, please tell us what we can improve.
9.
When preparing to leave the hospital, did you feel you have a good understanding of how to manage your health at home?
Yes, completely
Yes, somewhat
No
If no, please tell us what we can improve.
10.
Is there anyone you would like to recognize for the care they provided during your stay?
Yes
No
If yes, please tell us who you would like to recognize and why.
11.
Please rate SLMHC using any number from 1 - 10, where 1 is the WORST health centre possible and 10 is the BEST health centre possible.
1 - Worst
2
3
4
5
6
7
8
9
10 - Best
1 - Worst
2
3
4
5
6
7
8
9
10 - Best
12.
Would you recommend this hospital to your family and friends based on the quality of care provided?
Yes, definitely
Yes, somewhat
No
13.
Do you have any general comments or feedback for improvement that you would like to provide?
14.
Would you like to be contacted about the information you provided in this survey?
Yes
No
If yes, please provide your name and preferred method below (phone number or email address).
15.
Would you like to add your name to a list of clients to be contacted for input on future SLMHC projects/changes?
Yes
No
If yes, please provide your name and preferred method of contact below (phone number or email address).
If you would like to provide additional feedback, please ask any staff member for a Compliment/Feedback Form.
