Client Experience Questionnaire

Prairie Mountain Health (PMH) wants to provide the best care and services possible.  It is important to hear about your experience in order to make improvements to the way we provide care. Please take a few moments of your valuable time to fill out this questionnaire by selecting the response that best describes your experience.  No personal information is collected or shared unless you request follow up.

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* 1. Is this your first baby?

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* 2. What is your age?

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* 3. Where did you deliver your baby?

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* 4. My baby was delivered by:

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* Please choose the best answer for each of the following:

  Always Usually Rarely/Never Not Applicable
5. Upon admission, I was given appropriate information about what to expect.
6. Before providing care, staff members introduced themselves to me.
7. My doctor was responsive to my medical needs.
8. Staff talked to me about my health care options (e.g. medications/tests).
9. I was encouraged to take part in my care.
10. My health care provider used words I could understand.
11. I had access to the care I needed.
12. I felt staff had the training needed to care for me.

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* Please choose the best answer for each of the following:

  Always Usually Rarely/Never Not Applicable
13. I was treated with respect.
14. I saw the health care worker clean their hands before providing my care.
15. Staff worked well together to care for me.
16. My care was organized.
17. Staff involved me or my family in making decisions about my care.
18. My cultural needs were met.
19. My privacy was respected as best it could be.
20. The staff keeps my information confidential and secure.

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* 21. I was satisfied with the care provided by my nurse/midwife:

  Always Usually Rarely/Never Not Applicable
a. During labor.
b. In my care after birth.
c. While infant feeding.
d. Related to my newborn's care.

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* Please choose the best answer for each of the following:

  Always Usually Rarely/Never Not Applicable
22. I had information needed to make good decisions about my health.
23. I was comfortable expressing concerns about my care.
24. My concerns were taken seriously.
25. I was given information regarding follow-up of my care.
26. Visiting hours were adequate.
27. I was satisfied with my meals while in hospital.

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* Please choose the best answer for each of the following:
Newborn Care

  Always Usually Rarely/Never Not Applicable
28. I was involved with decisions on my newborn's care.
29. I saw the staff clean their hands before caring for my newborn(s).
30. Staff worked well together to care for my newborn(s).

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* Please choose the best answer for each of the following:
Infant Feeding

  Always Usually Rarely/Never Not Applicable
31. I was given adequate information on infant feeding, including feeding options.
32. a)  I was informed about infant feeding options such as breastfeeding or formula.
32. b)  This information allowed me to make an informed decision about how to feed my baby.
33. a)  Staff provided me with breastfeeding assistance within 1 hour of delivery.
33. b)  Staff provided me with ongoing support for breastfeeding throughout my hospital stay.
34. Staff provided information regarding hand expression of breast milk.

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* Please choose the best answer for each of the following:
Resources

  Always Usually Rarely/Never Not Applicable
35. a)  I was given the teaching booklet "Baby's Best Chance".
          i) I found this booklet helpful.
         ii) I did not need this booklet after my baby was born.

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* Please choose the best answer for each of the following:
Resources

  Always Usually Rarely/Never Not Applicable
35. b)  I was given the teaching booklet "Caring for Yourself After Baby is Born".
          i) I found this booklet helpful.
         ii) I did not need this booklet after my baby was born.

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* Please choose the best answer for each of the following:
Resources

  Always Usually Rarely/Never Not Applicable
35. c)  I was given the teaching booklet "Caring for Baby".
          i) I found this booklet helpful.
         ii) I did not need this booklet after my baby was born.

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* Please choose the best answer for each of the following:

  Always Usually Rarely/Never Not Applicable
36. I was given enough information on available supports after discharge (e.g. Public Health, Mental Health).
37. I feel my feedback would be used to improve care and services.
38. Overall, I was satisfied with the quality of care that I received.

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* Comments:

Additional comments/questions can be forwarded to:
Client/Patient Relations - toll free at 1-877-279-7858 or patientrelations@pmh-mb.ca

Thank you for your participation!

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