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).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank.

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* 1. 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.

Question Title

* 2. 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 health care 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.

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* 3. 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.

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* 4. 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.

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* 5. 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 wrist band, asked my date of birth)

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* 6. 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.

Question Title

* 7. Rivers Rehabilitation Program Specific Questions
(If question does not apply, leave blank)

  Strongly Agree Agree Disagree Strongly Disagree
a. My Nurses were knowledgeable regarding best practices in rehabilitation.
b. My Doctors were knowledgeable regarding best practices in rehabilitation.
c. My Physiotherapist was knowledgeable regarding best practices in rehabilitation.
d. My Occupational Therapist was knowledgeable regarding best practices in rehabilitation.

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* 8. e. I was satisfied with the care/service provided by:

  Strongly Agree Agree Disagree Strongly Disagree
1) Lab and X-ray
2) Housekeeping
3) Laundry
4) Recreation/Activities
5) Mental Health Resource Nurse
6) Home Care Case Coordinator

Question Title

* 9. .

  Strongly Agree Agree Disagree Strongly Disagree
f. During my stay, I got all the information I needed about my condition and treatment.
g. I received enough information from staff about what to do if I was worried about my condition or treatment plan after I left the hospital.

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* 10. h. Other services were coordinated for me before I was discharged:

  Strongly Agree Agree Disagree Strongly Disagree
1) Home Care
2) Equipment
3) Referrals

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* 11. .

  Strongly Agree Agree Disagree Strongly Disagree
i. My family and I were happy with the suggested visiting hours that worked with my rehabilitation schedule.
j. My rehabilitation team involved me in goal setting throughout my stay.
k. In general, I was satisfied with my meals.

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* 12. .

  Always Usually Sometimes Never
l. During your stay, after you pressed the call button, did you receive help in a timely manner?
m. During my stay, the area around my room was quiet at night.

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* 13. What is one thing we could do to improve your level of satisfaction with our care or service?

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* 14. Comments:

Demographics: (of the patient) Collected for statistical purposes only to target improvements.

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* 15. Gender:

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* 16. Ethnicity: 

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* 17. Age:

Rivers Rehabilitation Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with Rivers Rehabilitation patients or family members who might be interested in helping us review, design or provide feedback to our services.
By leaving your name, phone number and email address below, you are indicating your interest in partnering with Prairie Mountain Health (PMH) and are consenting to be contacted by Patient Relations.
Patient Relations will be in contact with you when an opportunity becomes available.

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* 18. Volunteer Contact Information:

Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations:  email   patientrelations@pmh-mb.ca    or  call   1-800-735-6596

 Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca 


Thank you for your participation! 

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