Patient satisfaction questionnaire
This questionnaire has been designed to assess your satisfaction from the services provided in this hospital. Please answer the questions carefully so that you can contribute to the improvement of the quality of the services provided in this center. (We sincerely thank you for your cooperation.)
Please specify how many times you have referred to the hospital: 10 2-40 More than5 0 |
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Age: |
Gender : Male0 Famale0 |
Marital status: single 0 Married 0 other0 |
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Education level: below diploma0 diploma 0 associate 0 B.A. 0 M.A.0 Ph.D. & higher0 |
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Hospitalization procedure: emergency0 clinic0 doctor’s office 0 |
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Topic |
Item being assessed |
Satisfied |
Partly satsfied |
Dissatisfied |
I didn’t refer there |
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Security |
The behaviors of security guards with you and provision of needed guidance |
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Reception |
The behaviors of the reception personnel |
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Services unit |
Provision of needed information upon reception (as regards insurance type, costs, room types) |
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Medical personnel |
The behaviors of the personnel of services unit |
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The behaviors of the medical personnel |
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Provision of the needed patient educations during treatment and upon discharge by the doctor |
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Respecting your privacy and dignity while examining you |
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Nursing personnel
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The behaviors of the nurses with you |
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Nurses’ concern over keeping the environment calm |
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Presence of nurses at wards on time and being available when needed |
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Provision of facilities needed for personal hygiene (clothes, blankets, etc.) |
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Nurses’ provision of the needed information to you to protect yourself (diet, activity level, use of medication, etc.) |
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Respecting your privacy and dignity while providing nursing care to you
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Laboratory
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The behaviors of the laboratory staff with you |
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Precision and skillfulness of the sample-taker |
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Food
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The quality of food |
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The method of serving food and collecting dishware |
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Observing the diet of the patient |
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The time of food distribution |
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The behaviors of the food distributor |
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Imaging
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The behaviors of the imaging staff (radiology and ultrasound) |
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Waiting duration in the imaging unit |
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Provision of the needed information and explanations |
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Operating room
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The behaviors of the operating room staff |
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Waiting duration in the operating room until the beginning of surgery |
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The hygiene of the environment |
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Respecting your privacy and dignity |
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CCU |
The behaviors of the nursing personnel with you |
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Respecting your privacy and dignity while providing nursing cares |
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The quality and quantity of cares and services provided by the nurses |
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Peace and quietness of the unit (noise, lighting, etc.) |
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Welfare amenities
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Peace and quietness of the unit (noise, lighting, etc.) |
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Discharge
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- If you needed medical care once again in the future, will you come to this hospital again?
Yes 0 No 0
- If any of your relatives needed hospitalization, will you recommend this hospital to them?
Yes 0 No 0
Quality improvement unit