Referring Doctors Satisfaction Questionnaire by lindash


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


Referring Doctors Satisfaction Questionnaire
This project provides you with a confidential and accurate method of assessing the referring doctor’s
expectations and satisfaction with your practice. You decide the number of referring doctors to survey
(minimum 20) and who you want to survey. Following analysis of the completed surveys, the results will be
reported for your evaluation and follow up. Ideas for improvement can be followed up through the
development of an action plan. The final stage will involve re-auditing your referring doctor’s satisfaction
after 12 months of implementing your action plan. This will take into account any changes that you may
have made during this period.
This is a Practice Review and Clinical Risk Management (PR&CRM) project in the RANZCOG
Continuing Professional Development program

          Stage                                             Activity                               PR&CRM Points

STAGE ONE                      Provide referring doctors with a copy of the survey along with an
Providing Referring            explanatory letter. You are encouraged to survey all referring
Doctors with                   doctors; however you might also like to include non-referring
                                                                                                     2 points in the
questionnaire.                 doctors. Once the surveys have been completed and returned to
                                                                                                   PR&CRM Category
                               RANZCOG, analysis will take place and a report will be issued to
                               the participant.
                               NOTE: Stage 1 questionnaires must be returned within 6
                               months of beginning this project.

STAGE TWO                      You will be provided with a report from the College which
Develop Action Plan.           outlines the results of your referring doctor’s satisfaction. You
                               will then be asked to develop an action plan, highlighting any        5 points in the
                               changes that you may wish to make to enhance referring              PR&CRM Category
                               doctor’s satisfaction. A copy of this must then be sent to the
Implement Action Plan.         College.

STAGE THREE                    Following implementation of the action plan a follow up survey is
Re-audit referring doctors.    conducted at 12 months, where you will be provided with a             8 points in the
                               second kit of surveys in order to re-audit referring doctor’s       PR&CRM Category
                               satisfaction. A brief comparative report will be provided.

Please note : We require a minimum of 20 completed referring doctor’s satisfaction questionnaires
to proceed with analysis. In the unfortunate event that we do not receive this minimum, we will be in
contact with participants. It may mean that they are unable to continue with the project. In this
situation, a refund of 50%, plus a summary of any raw data received will be available.

           Please keep a summary of your activity as verification documentation
 At the end of each stage, point 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
                        The Royal Australian and New Zealand College of
                              Obstetricians and Gynaecologists
                                      “Excellence in Women’s Health”


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

RANZCOG Fellows                       $AUD250.00 (includes 10% GST)                    $AUD235.00

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

Mail cheque/money orders to:
Referring Doctors 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, Victoria, 3002
                                                                                    is received


      Full Name:    _____________________________________________________________________

 Postal Address:    _____________________________________________________________________


         Suburb:    ___________________________        State:   ___________       Postcode:       ________

  Email address:    _____________________________________________________________________

 Please send me     _____________ questionnaires.


 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: 180QRD

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

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