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Patient Satisfaction Questionnaire (PSQ)

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					                             The Royal Australian and New Zealand College of
                                   Obstetricians and Gynaecologists
                                                “Excellence in Women’s Health”

                                                      www.ranzcog.edu.au




      Patient Satisfaction Questionnaire (PSQ)
This project provides you with a confidential and accurate method of assessing patient expectations and
satisfaction with your practice. Following analysis, the results will be reported for your evaluation and follow
up. Ideas for improving your practice can be followed up with the action plan that is to be developed from
the report. To complete the quality cycle, it is suggested that you re-audit your practice after 12 months to
re-assess your patients’ satisfaction.

The RANZCOG Patient Satisfaction Questionnaire focuses on:
    Patient expectations prior to a consultation
    Doctor-Patient relationship
    Information provided on treatment and medication discussed during the consultation
    Staff commitment and perceptions of staff regarding quality and efficiency of service provided

What does the survey involve?
          Stage                                             Activity                                 PR&CRM Points

STAGE ONE
Handing out                   Provide 100 consecutive patients with a questionnaire (provided
questionnaires to patients    by RANZCOG) to complete, following their consultation. The
                                                                                                       2 points in the
and return to College         patient places their completed survey in one of the blank
                                                                                                     PR&CRM Category
House.                        envelopes provided. Once all 100 questionnaires have been
                              completed, they should be returned to RANZCOG for analysis.
                              PLEASE NOTE: Stage 1 questionnaires must be returned
                              within 12 months of beginning this project.

STAGE TWO
Develop Action Plan.          You will be provided with a comprehensive report from the
                              College which outlines the results of your patient satisfaction
                              questionnaires. You will be asked to develop an action plan              5 points in the
                              based on the results of the initial survey, highlighting any changes   PR&CRM Category
                              that may be incorporated in your practice to promote future
Implement Action Plan.        patient satisfaction. A copy of this plan must be forwarded to
                              RANZCOG.


STAGE THREE
Re-audit patients and         Following implementation of the action plan for approximately 12
                                                                                                       8 points in the
return questionnaire to       months, you will be provided with a second kit of 100
                                                                                                     PR&CRM Category
College House.                questionnaires to re-audit patient satisfaction. A brief comparative
                              report will be provided.



           Please keep a summary of your activity as verification documentation
At the end of each stage, points will be automatically credited in the Practice Review
                       & Clinical Risk Management category.
         Completion of this entire activity – 15 Points in PR&CRM Category.
  For queries, contact PR&CRM staff on +61 3 9417 1699 or prcrm@ranzcog.edu.au

                                                                                                             Updated 10/12/09
                        The Royal Australian and New Zealand College of
                              Obstetricians and Gynaecologists
                                          “Excellence in Women’s Health”

                                               www.ranzcog.edu.au




              Patient Satisfaction Questionnaire
                         Order Form
 Prices (in Australian Dollars):                       Australia                     New Zealand, Overseas

RANZCOG Fellows                          $AUD550.00 (includes 10% GST)             $AUD500.00 (GST exempt)


Fax credit card orders to RANZCOG on +61 3 9415 9306

Mail cheque/money orders to:
Patient Satisfaction Questionnaire                                                    TAX INVOICE
RANZCOG, College House                                                            ABN 34 100 268 969
254 - 260 Albert Street                                                      This document becomes a Tax
                                                                             Invoice for GST when payment
EAST MELBOURNE VIC 3002
                                                                                        is received
Australia

REGISTRATION:

      Full Name:    _____________________________________________________________________

 Postal Address:    _____________________________________________________________________

                    _____________________________________________________________________

         Suburb:    ___________________________           State:    ___________       Postcode:       ________

  Email address:    _____________________________________________________________________

PAYMENT:

 Option 1:     CHEQUE – Please make all cheques payable to ‘RANZCOG’

 Option 2:     CREDIT CARD –  Visa              OR        MasterCard

  Name on Card:     _____________________________________                  Card Expiry:    _______ / _______

   Card number:     ____________     ____________      ____________         ____________

   Amount paid:     $AUD___________ including GST.            Signature:      _________________________
                                                                                          OFFICE USE ONLY: 180QPQ


* Overseas payments should be by international cheque drawn on an Australian Bank.
                                                                                                   Updated 10/12/09

				
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Description: Patient Satisfaction Questionnaire (PSQ)