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In your opinion, how have patient satisfaction ratings changed at your organization in the past year? Improved considerably Improved somewhat Has remained about the same Has declined somewhat Has declined considerably Don't know In your opinion, how important is patient satisfaction at your organization? It's a high priority It's a mid-level priority It's a low priority Don't know Does your organization have managers/staff dedicated to patient-satisfaction matters? Yes No Don't know How often does your organization track patient satisfaction? Daily basis for each patient Monthly or more often Quarterly Semiannually Yearly or less often We don't How is patient satisfaction primarily tracked? Questionnaires sent through the mail (in-house efforts) Follow-up telephone calls (in-house efforts) An outside firm has been hired to track patient satisfaction Suggestion boxes placed in facilities Other Has your organization initiated programs to improve patient satisfaction within the past year? Yes No Don't know What sector of the health care industry do you believe needs the most improvement in patient satisfaction? Hospitals Physicians Managed-care plans Nursing homes Outpatient providers Other What is the most compelling reason for your organization to improve customer satisfaction? Fear of losing patients to competitors Fear of losing employer contracts Fear of increase regulation Fear of damage to organization's reputation Other In your opinion, has patient satisfaction been shown to have a direct effect on your organization's bottom line? Yes No Patient Survey YOUR APPOINTMENT 1. Was it easy to make your appointment by phone? Y N 2. Were you able to obtain an appointment within a reasonable amount of time? Y N 3. Did you get after hours response if/when you needed it? Y N 4. Was your check-in process efficient? Y N 5. Was your wait time in the reception area unreasonable? Y N 6. Were you informed a check-in if you appointment time was delayed? Y N 7. Did the clinical staff keep you informed of Physician delays? Y N 8. Did your primary care physician schedule your initial visit in our office? Y N OUR STAFF 1. Did our staff member introduce themselves to you? Y N 2. Was our phone staff courteous and respectful? Y N 3. Was the person who scheduled your appointment courteous? Y N 4. Were our receptionists courteous and respectful? Y N 5. Were our nurses/medical assistants courteous and respectful? Y N 6. Was the person who responded to clinical questions you had courteous and respectful? Y N 7. Was our __________ staff courteous and respectful? Y N 8. Was our x-ray staff courteous and respectful? Y N OUR COMMUNICATION WITH YOU 1. Did your phone calls get answered promptly? Y N 2. Did you get advice or help when needed during office hours? Y N 3. Were we able to return your clinical calls in a timely manner? Y N 4. Did we give thorough instructions regarding medications & follow up care? Y N 5. Was it easy for you to obtain prescription refills by phone? Y N WHICH PHYSICIAN DID YOU SEE? Dr. ____________________ Dr. ____________________ Dr. ____________________ Dr. ____________________ YOUR VISIT WITH PROVIDER 1. Was the doctor willing to listen carefully to you? Y N 2. Did he take time to answer your questions? Y N 3. Did he spend enough time with you to address your needs? Y N 4. Did he explain things in a way you could understand? Y N 5. Did you feel your provider was courteous and respectful? Y N 6. Were you satisfied with the advice given to you about your _________ problem? Y N 7. Would you recommend the provider to others? Y N OUR FACILITY 1. Were you comfortable with our facility? Y N 2. Was there adequate parking? Y N 3. Were the signage and directions easy to follow? Y N YOUR OVERALL SATISFACTION 1. Were you satisfied with our practice? Y N 2. Were you satisfied with the quality of your physician/medical care? Y N 3. Were you satisfied with the quality of our clinical staff? Y N SOME INFORMATION ABOUT YOU 1. Your gender M F 2. Are you a new patient? Y N 3. Your age: Under 18 18-30 31-40 41-50 51-60 Over 60 PLEASE TELL US HOW WE CAN IMPROVE OUR SERVICES TO YOU WE ENCOURAGE AND APPRECIATE YOUR COMMENTS May we contact you regarding this survey? Y N Your Name (if yes): Contact Phone Number: |