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* 1. Select from the following options the word(s) that best describes your organization. (multiple select)

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* 2. Location of organization:

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* 3. Organization network size? (# of beds)

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* 4. Your Certification/Qualification: (check all that apply)

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* 5. What is the title of your position?

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* 6. If you have direct patient care responsibilities, what is your typical staff/patient ratio?

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* 7. Rank your clinical staff/resource concerns:

  Not a Concern Mild Concern Moderate Concern High Concern Highest Concern
Staff Safety/Duress
Manual Documentation
Staff Engagement/Recognition
Staff Morale
Resourcing Challenges

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* 8. Rank your resourcing challenges:

  Not a Concer Mild Concern Moderate Concern High Concern Highest Concern
Staff Turnover
COVID
PTO/Retirements
Resourcing Challenges/1:1 Sitters
Staff/Patient Ratios

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* 9. Rank your confidence in your organization's solutions and processes to adequately address the following:

  Not a Concern Mild Concern Moderate Concern High Concern Highest Concern
Staff Safety/Duress
Manual Documentation
Staff Engagement/Recognition
Staff Morale
Resourcing Challenges

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* 10. Rank your organization's level of prioritization to evaluate solutions and processes to adequately address the following in 2021:

  Not a Priority Low Priority Moderate Priority High Priority Highest Priority
Staff Safety/Duress
Manual Documentation
Staff Engagement/Recognition
Staff Morale
Resourcing Challenges

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* 11. Rank your confidence in your organization's solutions and processes to adequately address the following:

  Not a Concern Mild Concern Moderate Concern High Concern Highest Concern
Patient Falls
Pressure Injuries
Infection Control
Protocol Compliance Adherence (Rounding/Bedside)
Family Engagement
Remote Monitoring

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* 12. How does your organization measure patient rounding? (check all that apply)

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* 13. From where are you receiving your new patient/resident leads? 

  Low Volume Some Volume Moderate Volume High Volume Highest Volume
Social Media
Online Directories (Caring.com, etc.)
Hospital Discharge Planners/Case Managers
Physician Referral
Current Patients and/or Families
Company Website 
Phone Call
Assisted Living Facility
Home Care Agency
Facility Employees
Search Engines (Google, etc.)
Other Referral Sources

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* 14. What prevents your organization from embracing new technology/solutions? (check all that apply)

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* 15. Resources you acquire healthcare industry information from? (check all that apply)

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* 16. Resources you acquire healthcare industry information from? (check all that apply)

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