Patient Experience Evaluation - Inpatient

Please tell us about your experience while staying in hospital. We would be grateful if you would complete this survey to let us know!

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* 1. This survey is completed by:

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* 2. Which inpatient unit were you admitted to?

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* 3. Please enter the postcode of where you live

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* 4. Did you receive a 'Welcome Pack' containing information about:

	Yes	No	Unsure
The Australian Healthcare Rights?	The Australian Healthcare Rights? Yes	The Australian Healthcare Rights? No	The Australian Healthcare Rights? Unsure
Ryan's Rule (Brochure or Verbal)?	Ryan's Rule (Brochure or Verbal)? Yes	Ryan's Rule (Brochure or Verbal)? No	Ryan's Rule (Brochure or Verbal)? Unsure
How to provide feedback?	How to provide feedback? Yes	How to provide feedback? No	How to provide feedback? Unsure

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* 5. Please answer the following questions to rate your experience:

	Always	Usually	Sometimes	Never
Did you feel you were treated with courtesy, dignity and respect?	Did you feel you were treated with courtesy, dignity and respect? Always	Did you feel you were treated with courtesy, dignity and respect? Usually	Did you feel you were treated with courtesy, dignity and respect? Sometimes	Did you feel you were treated with courtesy, dignity and respect? Never
Did you feel staff communicated with openness and empathy?	Did you feel staff communicated with openness and empathy? Always	Did you feel staff communicated with openness and empathy? Usually	Did you feel staff communicated with openness and empathy? Sometimes	Did you feel staff communicated with openness and empathy? Never
Were you involved in decisions about your/your child's care and treatment?	Were you involved in decisions about your/your child's care and treatment? Always	Were you involved in decisions about your/your child's care and treatment? Usually	Were you involved in decisions about your/your child's care and treatment? Sometimes	Were you involved in decisions about your/your child's care and treatment? Never
When you asked questions about your/your child's condition, did you receive answers that you could understand ?	When you asked questions about your/your child's condition, did you receive answers that you could understand ? Always	When you asked questions about your/your child's condition, did you receive answers that you could understand ? Usually	When you asked questions about your/your child's condition, did you receive answers that you could understand ? Sometimes	When you asked questions about your/your child's condition, did you receive answers that you could understand ? Never
Did staff listen to your requests and deal with them in a timely manner?	Did staff listen to your requests and deal with them in a timely manner? Always	Did staff listen to your requests and deal with them in a timely manner? Usually	Did staff listen to your requests and deal with them in a timely manner? Sometimes	Did staff listen to your requests and deal with them in a timely manner? Never
Did you feel you/ your child received high quality and safe care whilst an inpatient?	Did you feel you/ your child received high quality and safe care whilst an inpatient? Always	Did you feel you/ your child received high quality and safe care whilst an inpatient? Usually	Did you feel you/ your child received high quality and safe care whilst an inpatient? Sometimes	Did you feel you/ your child received high quality and safe care whilst an inpatient? Never
Did you feel comfortable leaving your child (e.g. for a shower, or to get a coffee)?	Did you feel comfortable leaving your child (e.g. for a shower, or to get a coffee)? Always	Did you feel comfortable leaving your child (e.g. for a shower, or to get a coffee)? Usually	Did you feel comfortable leaving your child (e.g. for a shower, or to get a coffee)? Sometimes	Did you feel comfortable leaving your child (e.g. for a shower, or to get a coffee)? Never

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* 6. Please answer the following questions to rate your experience:

	Excellent	Good	Fair	Poor
Overall, how would you rate the level of teamwork amongst the staff that provided care to you/your child?	Overall, how would you rate the level of teamwork amongst the staff that provided care to you/your child? Excellent	Overall, how would you rate the level of teamwork amongst the staff that provided care to you/your child? Good	Overall, how would you rate the level of teamwork amongst the staff that provided care to you/your child? Fair	Overall, how would you rate the level of teamwork amongst the staff that provided care to you/your child? Poor
How would you rate your/your child's overall inpatient experience?	How would you rate your/your child's overall inpatient experience? Excellent	How would you rate your/your child's overall inpatient experience? Good	How would you rate your/your child's overall inpatient experience? Fair	How would you rate your/your child's overall inpatient experience? Poor

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* 7. Would you recommend this hospital/health service to your friends and family?

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* 8. Is there a member of staff you would like to thank? If so, please provide the details.

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* 9. What else would you like to tell us about?

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* 10. Do you consent to Children's Health Queensland sharing your feedback?

Yes

Thank you for taking the time to complete this survey.
If you would like to tell us more about your experience please
Email: CHQ_PatientExperience@health.qld.gov.au
Or you can speak with our patient experience team by calling (07) 30681120

Please do not provide any personal information on this form as your feedback will be collated into Survey Monkey – an
electronic online system.