Client Experience Questionnaire

Tell us about your experience!  Your feedback helps us to improve the way we provide care.  This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness, and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank

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* What location did you visit your Nurse Practitioner?

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* Dignity, Respect and Trust:
If the question does not apply, leave blank

  Strongly Agree Agree Disagree Strongly Disagree
a.  I was treated with respect.
b.  My privacy was respected as best it could be.
c.  My cultural needs were considered.
(e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
d.  Before providing care, staff members introduced themselves to me, where appropriate.
e.  In general, staff were compassionate.

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* Information Sharing:
If the question does not apply, leave blank

  Always Usually Sometimes Never
a.  Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.)
b.  Staff talked to me about my health care options.
(e.g. procedures/tests)
c.  My health care provider used words I could understand.
d.  I had the necessary information needed to make good decisions about my health.
e.  The staff kept my information confidential and secure.

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* Participation:
If the question does not apply, leave blank

  Always Usually Sometimes Never
a.  Staff involved me or my family/support system in making decisions about my care.
b.  I was encouraged to take part in my care as much as I was able.
c.  My choices were respected.
d.  I was comfortable expressing concerns about my care.

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* Accessibility and Responsiveness:
If the question does not apply, leave blank

  Strongly Agree Agree Disagree Strongly Disagree
a.  My care was well coordinated.
b.  I was cared for in a timely manner.
c. I had access to the care I needed.
d.  My concerns were taken seriously.
e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey.

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* Quality:
If the question does not apply, leave blank

  Always Usually Sometimes Never
a.  I saw the health care provider(s) clean their hands before providing my care.
b.  My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth)

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* Quality:
If the question does not apply, leave blank

  Strongly Agree Agree Disagree Strongly Disagree
c.  My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. wet floors, icy side walks, uneven surfaces, electrical cords, etc.).
d.  I felt staff were up to date on the skills needed to provide my care.
e.  Overall, I was satisfied with the quality of care I received.

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* Nurse Practitioner Program Specific Questions:
If the question does not apply, leave blank

  Strongly Agree Agree Disagree Strongly Disagree
a.  I felt my care was specific to my personal needs.
b. The clinic made me feel welcome.
c. My privacy and confidentiality was protected.
d.  I feel my Nurse Practitioner is up to date on the latest research/practice guidelines.
e.  I was satisfied with the length of time it took to be seen by my Nurse Practitioner, from the day I called to book an appointment until the day I was seen.
f.  During my appointment, my Nurse Practitioner provided information on other programs or services that may be helpful to me.
g.  For clients who had a virtual appointment (e.g. phone, zoom, etc.) my health care needs were met.

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* Why did you choose a Nurse Practitioner for your care?

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* What is one thing we could do to improve care provided by Nurse Practitioners in Prairie Mountain Health?

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* Gender:

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* Ethnicity (race):

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* Age of patient:

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* Comments:

Nurse Practitioner Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Nurse Practitioner patients or family members who might be interested in helping us review,
design or provide feedback to our services.
By leaving your name, phone number and email address below, you are indicating your interest in partnering with Prairie Mountain Health (PMH) and are consenting to be contacted by Patient Relations.
Patient Relations will be in contact with you when an opportunity becomes available.

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* Volunteer Contact Information

Forward additional Concerns or Compliments regarding your care to Patient Relations.

Patient Relations:  email  patientrelations@pmh-mb.ca or call  1-800-735-6596

Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca 

Thank you for your participation! 

 

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