Patient Journey Survey Email Survey Detail Case Number Patient Name Contact Number (Optional) Admission Admission was quick and efficient 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Staff acknowledged my presence, were pleased and introduced themselves 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None The hospital rules and security of values were explained 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Staff treated patients and visitors with respect and courtesy 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Nursing Care Nurses displayed compassion and care 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Timeous administration of my medication 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Was my pain controlled 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None All information was provided by the nurse on discharge (e.g. Follow-up visits, wound care, etc.) 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Nurses treat members with courtesy and respect 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Nurses listen carefully to members. 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Nurses explain things in a way members can understand. 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Doctors Level of care provided by the doctor 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Doctors treat members with courtesy and respect 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Doctors listen carefully to members 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Doctors explain things in a way members can understand 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Outsourced Services Overall care from blood lab staff 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Overal care from X-ray department staff 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Overall care from security staff 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Overall food service from catering 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Responsive of staff Members receive help when pressing call button 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Hospital Environment Room and bathroom are kept clean 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Room quiet at night 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Medication Information Staff explain to members what the medicine is for 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Possible side effects to medicine explained well 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Overall experience Would you recommend this hospital 😃 Always 🙂 Usually 🙃 Sometimes 😐 Never 🙁 N/A None Your Comment WARD (optional) Time's up
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