Patient Survey

Within Outpatient services we are continually seeking to improve the care we offer. The views of our patients are of utmost importance to use in finding out what improvements we need to make.

Please take a few minutes to complete this questionnaire and tell us about your experience today.

All responses are anonymous. If you require any assistance in completing the questionnaire please ask a member of staff. When you have completed the questionnaire, place in the identified box.

	Yes	No
Given a choice of appointment times?	Given a choice of appointment times? Yes	Given a choice of appointment times? No
Was your appointment changed to a later date by the hospital?	Was your appointment changed to a later date by the hospital? Yes	Was your appointment changed to a later date by the hospital? No
Given a number to contact if you had any questions?	Given a number to contact if you had any questions? Yes	Given a number to contact if you had any questions? No
Told that you could bring a significant other to your appointment?	Told that you could bring a significant other to your appointment? Yes	Told that you could bring a significant other to your appointment? No
Given adequate information on how to find the department?	Given adequate information on how to find the department? Yes	Given adequate information on how to find the department? No
Given adequate information on car parking facilities?	Given adequate information on car parking facilities? Yes	Given adequate information on car parking facilities? No

Yes

Given a choice of appointment times?

Given a choice of appointment times? Yes

Given a choice of appointment times? No

Was your appointment changed to a later date by the hospital?

Was your appointment changed to a later date by the hospital? Yes

Was your appointment changed to a later date by the hospital? No

Given a number to contact if you had any questions?

Given a number to contact if you had any questions? Yes

Given a number to contact if you had any questions? No

Told that you could bring a significant other to your appointment?

Told that you could bring a significant other to your appointment? Yes

Told that you could bring a significant other to your appointment? No

Given adequate information on how to find the department?

Given adequate information on how to find the department? Yes

Given adequate information on how to find the department? No

Given adequate information on car parking facilities?

Given adequate information on car parking facilities? Yes

Given adequate information on car parking facilities? No

	Yes	No
Able to find the department easily?	Able to find the department easily? Yes	Able to find the department easily? No
Greeted courteously?	Greeted courteously? Yes	Greeted courteously? No

Yes

Able to find the department easily?

Able to find the department easily? Yes

Able to find the department easily? No

Greeted courteously?

Greeted courteously? Yes

Greeted courteously? No

	Yes	No
Introduce themselves to you?	Introduce themselves to you? Yes	Introduce themselves to you? No
Explain what would happen in the assessment / treatment?	Explain what would happen in the assessment / treatment? Yes	Explain what would happen in the assessment / treatment? No
Did you have enough time to discuss your health or medical problem with the doctor?	Did you have enough time to discuss your health or medical problem with the doctor? Yes	Did you have enough time to discuss your health or medical problem with the doctor? No
Explain the risks and / or benefits of the treatment in a way that you could understand?	Explain the risks and / or benefits of the treatment in a way that you could understand? Yes	Explain the risks and / or benefits of the treatment in a way that you could understand? No
Listen to and appreciated your concerns and needs?	Listen to and appreciated your concerns and needs? Yes	Listen to and appreciated your concerns and needs? No
Inform you what the next stage of your treatment would be?	Inform you what the next stage of your treatment would be? Yes	Inform you what the next stage of your treatment would be? No
Did you have confidence and trust in the doctor / nurse examining and treating you?	Did you have confidence and trust in the doctor / nurse examining and treating you? Yes	Did you have confidence and trust in the doctor / nurse examining and treating you? No

Yes

Introduce themselves to you?

Introduce themselves to you? Yes

Introduce themselves to you? No

Explain what would happen in the assessment / treatment?

Explain what would happen in the assessment / treatment? Yes

Explain what would happen in the assessment / treatment? No

Did you have enough time to discuss your health or medical problem with the doctor?

Did you have enough time to discuss your health or medical problem with the doctor? Yes

Did you have enough time to discuss your health or medical problem with the doctor? No

Explain the risks and / or benefits of the treatment in a way that you could understand?

Explain the risks and / or benefits of the treatment in a way that you could understand? Yes

Explain the risks and / or benefits of the treatment in a way that you could understand? No

Listen to and appreciated your concerns and needs?

Listen to and appreciated your concerns and needs? Yes

Listen to and appreciated your concerns and needs? No

Inform you what the next stage of your treatment would be?

Inform you what the next stage of your treatment would be? Yes

Inform you what the next stage of your treatment would be? No

Did you have confidence and trust in the doctor / nurse examining and treating you?

Did you have confidence and trust in the doctor / nurse examining and treating you? Yes

Did you have confidence and trust in the doctor / nurse examining and treating you? No

	Yes	No
Did you require a further appointment?	Did you require a further appointment? Yes	Did you require a further appointment? No
Were the reception staff clear in explaining when this would be?	Were the reception staff clear in explaining when this would be? Yes	Were the reception staff clear in explaining when this would be? No
Did you leave with this appointment?	Did you leave with this appointment? Yes	Did you leave with this appointment? No
If not, what did the staff inform you?	If not, what did the staff inform you? Yes	If not, what did the staff inform you? No
Were you satisfied with the information received?	Were you satisfied with the information received? Yes	Were you satisfied with the information received? No

Yes

Did you require a further appointment?

Did you require a further appointment? Yes

Did you require a further appointment? No

Were the reception staff clear in explaining when this would be?

Were the reception staff clear in explaining when this would be? Yes

Were the reception staff clear in explaining when this would be? No

Did you leave with this appointment?

Did you leave with this appointment? Yes

Did you leave with this appointment? No

If not, what did the staff inform you?

If not, what did the staff inform you? Yes

If not, what did the staff inform you? No

Were you satisfied with the information received?

Were you satisfied with the information received? Yes

Were you satisfied with the information received? No

	Yes	No
Allowed enough time to discuss your concerns and needs?	Allowed enough time to discuss your concerns and needs? Yes	Allowed enough time to discuss your concerns and needs? No
Did you feel involved as much as you wanted to be in decisions about your care and treatment?	Did you feel involved as much as you wanted to be in decisions about your care and treatment? Yes	Did you feel involved as much as you wanted to be in decisions about your care and treatment? No
Given enough privacy when discussing your condition and treatment?	Given enough privacy when discussing your condition and treatment? Yes	Given enough privacy when discussing your condition and treatment? No
Treated with respect and dignity?	Treated with respect and dignity? Yes	Treated with respect and dignity? No
Did you witness our staff washing / applying alcohol gel to their hands?	Did you witness our staff washing / applying alcohol gel to their hands? Yes	Did you witness our staff washing / applying alcohol gel to their hands? No

Yes

Allowed enough time to discuss your concerns and needs?

Allowed enough time to discuss your concerns and needs? Yes

Allowed enough time to discuss your concerns and needs? No

Did you feel involved as much as you wanted to be in decisions about your care and treatment?

Did you feel involved as much as you wanted to be in decisions about your care and treatment? Yes

Did you feel involved as much as you wanted to be in decisions about your care and treatment? No

Given enough privacy when discussing your condition and treatment?

Given enough privacy when discussing your condition and treatment? Yes

Given enough privacy when discussing your condition and treatment? No

Treated with respect and dignity?

Treated with respect and dignity? Yes

Treated with respect and dignity? No

Did you witness our staff washing / applying alcohol gel to their hands?

Did you witness our staff washing / applying alcohol gel to their hands? Yes

Did you witness our staff washing / applying alcohol gel to their hands? No

Patient Survey

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* 1. Have you ever visited this outpatients department before?

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* 2. Before your appointment, were you…

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* 3. On arriving at your appointment, were you...

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* 4. Were you told how long you would have to wait?

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* 5. How long after the stated appointment time did the appointment start?

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* 6. Who did you see?

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* 7. In your appointment, did the staff...

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* 8. After your appointment...

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* 9. Overall, in your appointment, were you...

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* 10. Was the main reason you went to the outpatients department dealt with to your satisfaction?

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* 11. Would you recommend this service to friends and family if they needed similar care or treatment?

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* 12. Overall, how would you rate the care you received at this appointment?

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* 13. Comments/ Is there anything we could do differently?: