Inpatient Patient and Family Experience Survey

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* 1. Who is completing this survey?

Patient

Family Member/Caregiver

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* 2. Your experience was at which Huron Health System Facility?

Alexandra Marine and General Hospital (AMGH - Goderich)

South Huron Hospital (SHH - Exeter)

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* 3. Did the health professionals treating and examining you introduce themselves?

Yes, all of the staff introduced themselves

Some of the staff introduced themselves

Very few of the staff introduced themselves

Don't know/Can't remember

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* 4. Do you feel that there was good communication about your care between doctors, nurses and other hospital staff?

Never

Sometimes

Usually

Always

Don't know/Not sure

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* 5. During this hospital stay, did you get all of the information you needed about your condition and treatment?

Never

Sometimes

Usually

Always

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* 6. Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit?

Never

Sometimes

Usually

Always

Not applicable

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* 7. Were you involved as much as you wanted to be in decisions about your care and treatment?

Never

Sometimes

Usually

Always

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* 8. Were you able to get a member of the hospital staff to help you when you needed attention?

Yes, always

Sometimes

No, never

I did not need attention

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* 9. Before you left the hospital, did you have a clear understanding about all of your prescribed medications, including those you were taking before your hospital stay?

Not at all

Partly

Quite a bit

Completely

Not applicable

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* 10. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

Not at all

Partly

Quite a bit

Completely

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* 11. Overall...(Please pick a number)

0 I had a very poor experience

10 I had a very good experience

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* 12. What else would you like to say about this inpatient experience? (Please do not include any names, contact information, or identifying information)

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* 13. Is there a staff member or group that you would like to recognize for providing exceptional care or service?

If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.