Patient satisfaction questionnaire

visits:119

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

Age:

Gender   : Male0    Famale0

Marital status:    single  0    Married 0   other0

Education level:    below diploma0   diploma 0  associate  0  B.A. 0  M.A.0   Ph.D. & higher0

Department:

Date:

Filled out by:

patient0   campanion0   interviewer 0

Hospitalization procedure:  emergency0   clinic0   doctor’s office 0

Topic

Item being assessed

Satisfied

Partly satsfied

Dissatisfied

I didn’t refer there

Security

The behaviors of security guards with you and provision of needed guidance

Reception

The behaviors of the reception personnel

Services unit

Provision of needed information upon reception (as regards insurance type, costs, room types)

Medical

personnel

The behaviors of the personnel of services unit

The hygiene of the rooms, WCs, etc.

The behaviors of the medical personnel

Provision of the needed patient educations during treatment and upon discharge by the doctor

Doctors’ manner of responding to patients

Presence of doctors at the wards on time and being available when needed

Respecting your privacy and dignity while examining you

Nursing personnel

The behaviors of the nurses with you

Nurses’ concern over keeping the environment calm

Presence of nurses at wards on time and being available when needed

Provision of facilities needed for personal hygiene (clothes, blankets, etc.)

Nurses’ provision of the needed information to you to protect yourself (diet, activity level, use of medication, etc.)

Respecting your privacy and dignity while providing nursing care to you

Laboratory

The behaviors of the laboratory staff with you

Precision and skillfulness of the sample-taker

Food

The quality of food

The method of serving food and collecting dishware

Observing the diet of the patient

The time of food distribution

The behaviors of the food distributor

Imaging

The behaviors of the imaging staff (radiology and ultrasound)

Waiting duration in the imaging unit

Provision of the needed information and explanations

Operating room

The behaviors of the operating room staff

Waiting duration in the operating room until the beginning of surgery

The hygiene of the environment

Respecting your privacy and dignity

CCU

The behaviors of the nursing personnel with you

Respecting your privacy and dignity while providing nursing cares

The quality and quantity of cares and services provided by the nurses

Peace and quietness of the unit (noise, lighting, etc.)

Welfare amenities

Ventilation of the rooms

Peace and quietness of the unit (noise, lighting, etc.)

Hygiene of the environment

Appropriateness of the visiting hours

Helping and supporting

Facilities for your companions (food, chair, etc.)

Availability of contacting tools (telephone)

Availability of an appropriate place for conducting religious deeds

The quality of ambulance services (if you have used it)

Respecting your privacy and separating the spaces where men and women stay

Guiding signs that help you find different units

Discharge

The quickness of completing the discharge process

The behaviors and guidance of the staff while discharging you

The cost of services received by the hospital

               

  1. If you needed medical care once again in the future, will you come to this hospital again?

Yes 0                No 0

  1. If any of your relatives needed hospitalization, will you recommend this hospital to them?

Yes 0                No 0

Quality improvement unit

Last Update At : 18 May 2022