Canossa Private Hospital Patient Experience Survey

Questions 1-12 of this survey contain the Australian Hospital Patient Experience Question Set developed with patients by the Australian Commission on Safety and Quality in Health Care.

Thank you for taking the time to complete this survey and telling us about your hospital experience.

Your feedback helps us to find out what we are doing well, and if there is anything that could be changed or improved.

If you would like to be contacted about the feedback you have provided, please leave your details below.

Your survey answers and information are confidential.

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Date (Required.)

Date

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Ward: (Required.)

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Your Name (Optional):

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Your Contact Number (Optional):

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Question 1
Staff listened to you (Required.)

  Always Mostly Sometimes Rarely Never Does not apply
Satisfaction Level

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Question 2
Staff made sure you got everything you needed. (Required.)

  Always Mostly Sometimes Rarely Never
Satisfaction Level
If you ticked always or mostly for question 2
  • do not answer question 3
  • go to question 4.

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Question 3
Staff told you why they could not give you what you needed.

  Always Mostly Sometimes Rarely Never
Satisfaction Level

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Question 4
You felt cared for. (Required.)

  Always Mostly Sometimes Rarely Never
Satisfaction Level

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Question 5
You felt included when decisions were made about your treatment and care.

Treatment can mean:
  • medicine
  • surgery.
 (Required.)

  Always Mostly Sometimes Rarely Never
Satisfaction Level

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Question 6
You got the information you needed about your treatment and care. (Required.)

  Always Mostly Sometimes Rarely Never
Satisfaction Level

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Question 7
All staff who cared for you:
  • worked together
  • shared the right information about you.
 (Required.)

  Always Mostly Sometimes Rarely Never Does not apply
Satisfaction Level

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Question 8
You got pain medicine if you needed it. (Required.)

  Always Mostly Sometimes Rarely Never Does not apply
Satisfaction Level

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Question 9
You felt safe when you got treatment and care. (Required.)

  Always Mostly Sometimes Rarely Never
Satisfaction Level

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Question 10
Your treatment led to physical harm or distress that you did not expect.

Physical harm means you get hurt.
Distress means you feel very upset. (Required.)

If you ticked no to question 10
  • do not answer question 11
  • go to question 12.

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Question 11
Staff talked to you about the harm and distress that happened to you.

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Question 12
Overall your treatment and care in hospital was (Required.)

  Very good Good OK Bad Very bad
Satisfaction Level

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Question 13
Was information about payment and your payment responsibilities provided to you? (Required.)

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Question 14
On a scale from 0-10, how likely are you to recommend Canossa Private Hospital to a family member or friend? (Required.)

Thank you for your participation. Your feedback is greatly appreciated and helps us to continuously improve at Canossa Private Hospital.

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