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					                                              Patient Satisfaction Survey


Conducting patient satisfaction surveys at your facility can provide excellent information regarding how to improve the
quality of care. When performed thoughtfully and with adequate follow-up, the results of these surveys can immediately
affect the way your practice does business. Satisfied customers are critical to the continued success of your facility.

This Excel Workbook contains five worksheets or tabs to help your laboratory perform a Patient Satisfaction Survey. The
worksheet contains an actual Survey for you to print and distribute to your patients. In addition there is a worksheet to
tabulate and record the patient's responses to the survey. The worksheet automatically calculates the results and
highlights areas for improvement based off of predetermined thresholds that you set. Finally, the workbook contains a
template for recording the minutes of your quality improvement meeting based on the results of the survey.


Patient Satisfaction Survey Instructions

1. Customize the patient survey located on the "Survey" tab (Pink tab) by typing the name of your facility
2. Print the survey and distribute to patients using the distribution method selected by your facility
3. Collect and tabulate the results. The results are then entered on the "DataCollection and Analysis" tab (blue tab)
4. The information from the Data Collection and Analysis worksheet is automatically transferred to the "Results"
worksheet (yellow tab)
5. On the results worksheet, you must enter the expected threshold for each indicator by clicking on the arrow next to the
cell.




6. Record the findings and discussion from your quality improvement meeting on the "Meeting Minutes" template (Purple
tab). The results from your survey will automatically be transferred to the "Meeting Minutes" template.
7. To print the entire workbook click on File then Print and choose
Comments About Administering a Patient Satisfaction Survey

How to Give the Survey to Patients:
To ensure consistency in the administration of the Patient Satisfaction Survey, it is suggested that the Survey be given to
patients in one of the two ways listed below.

1. A stack of the Surveys is made and readily available to patients at the time they check out upon completion of the test.
If the surveys are administered this way, have an envelope or box, marked "Completed Patient Satisfaction Surveys" right
next to the stack of Surveys for patients to put the completed survey into.

2. Someone on staff hands the Survey to patients at the end of their visit and asks them to complete it prior to leaving the
facility. After the patient has completed the survey, immediately place the Survey in an envelope and do not read any of
the patient's responses, or show the patient where they can deposit their Survey. As an alternative, the survey can be
handed to every third or fourth patient. This method usually results in approximately a 75% response rate.

3. Surveys are handed to every patient at the completion of the test along with an addressed return enveloped to the
mailed back to the facility. This method usually results in approximately 35% or less response rate.

When the Survey is given to patients, be sure to ell them that they are helping you improve the quality of your services
and that all of the responses to the Survey will be kept confidential/anonymous.


Sample Size:
As a general rule of thumb, a sample size of with a minimum of 25 - 40 patients is acceptable. The requirement of 25 - 40
minimum can be explained by the concept of Margin of Error. This is calculated by taking the square root of the sample
size and dividing it into 1, then multiplying by 100%. A graph would show that a sample size of 25 gives a Margin of Error
at 20%. Actually, by this method the most practical sample size is 40, giving a Margin of Error at 15%.
                                   (Your Facility Name Here)
                                      Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are
meeting your needs. Your responses will help us to improve the quality of care we provide. All
responses will be kept confidential and anonymous. Thank you for your time



Please circle how well you think we are doing in the following areas:   Great Good      OK       Fair   Poor
                                                                          5    4         3        2      1
Facility and Convenience:
    Hours of Operation                                                    5       4          3    2      1
    Convenience of the facility location                                  5       4          3    2      1
    Cleanliness of the facility                                           5       4          3    2      1
    Waiting time in the reception area                                    5       4          3    2      1
    Comfort while waiting                                                 5       4          3    2      1
Staff:
    Explanation of the procedure                                          5       4          3    2      1
    Questions answered                                                    5       4          3    2      1
    Friendly and helpful to you                                           5       4          3    2      1
    Knowledgeable and professional                                        5       4          3    2      1
    Modesty respected                                                     5       4          3    2      1
    Confidentiality respected (HIPPA)                                     5       4          3    2      1
Overall satisfaction:
    Overall impression of visit                                           5       4          3    2      1
    Willingness to return                                                 5       4          3    2      1
    Likelihood of referring to others                                     5       4          3    2      1

What did you like best about our facility?




What did you like least about our facility?




Suggestions for improvement?




Some information about you:

    Gender:                                   Age:                      Are you:
    Male                                      Under 18                  First time patient
    Female                                    18-30                     Returning patient
                                              31-40
                                              41-50
                                              51-60
                                              61-70
                                              Over 70
                                             (Your Facility Name Here)
                                              Patient Satisfaction Survey
                                                    Data Collection


                                                          Great   Good      OK        Fair       Poor      No
Question                                                                                                           Total
                                                            5      4         3         2          1     Response
Facility and Convenience:
   Hours of Operation                                                                                               0
   Convenience of the facility location                                                                             0
   Cleanliness of the facility                                                                                      0
   Waiting time in the reception area                                                                               0
   Comfort while waiting                                                                                            0
Staff:
   Explanation of the procedure                                                                                     0
   Questions answered                                                                                               0
   Friendly and helpful to you                                                                                      0
   Knowledgeable and professional                                                                                   0
   Modesty respected                                                                                                0
   Confidentiality respected (HIPPA)                                                                                0
Overall satisfaction:
   Overall impression of visit                                                                                      0
   Willingness to return                                                                                            0
   Likelihood of referring to others                                                                                0
What did you like best about our facility?




What did you like least about our facility?




Suggestions for improvement?




Some information about you:

   Gender:                                    Age:                       Are you:
   Male                                       Under 18                   First time patient
   Female                                     18-30                      Returning patient
       Total     0                            31-40                                      Total    0
                                              41-50
                                              51-60
                                              61-70
                                              Over 70
                                                  Total     0
                                              (Your Facility Name Here)
                                              Patient Satisfaction Survey
                                                       Results


                                                            Poor
                                                                      Great     Good          OK          Fair     Poor
Question                                                  Threshold
                                                                        5        4             3           2        1
                                                             (%)
Facility and Convenience:
   Hours of Operation                                                 #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Convenience of the facility location                               #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Cleanliness of the facility                                        #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Waiting time in the reception area                                 #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Comfort while waiting                                              #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
Staff:
   Explanation of the procedure                                       #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Questions answered                                                 #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Friendly and helpful to you                                        #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Knowledgeable and professional                                     #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Modesty respected                                                  #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Confidentiality respected (HIPPA)                                  #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
Overall satisfaction:
   Overall impression of visit                                        #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Willingness to return                                              #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
   Likelihood of referring to others                                  #DIV/0!   #DIV/0!    #DIV/0!      #DIV/0!   #DIV/0!
What did you like best about our facility?
0




What did you like least about our facility?
0




Suggestions for improvement?
0




Some information about you:

   Gender:                                     Age:                                       Are you:
   Male        #DIV/0!                         Under 18               #DIV/0!             First time patient      #DIV/0!
   Female      #DIV/0!                         18-30                  #DIV/0!             Returning patient       #DIV/0!
                                               31-40                  #DIV/0!
                                               41-50                  #DIV/0!
                                               51-60                  #DIV/0!
                                               61-70                  #DIV/0!
                                               Over 70                #DIV/0!
                                                (Your Facility Name Here)
                                                   Patient Satisfaction Survey
                                                        Meeting Minutes

Date of Staff Meeting:

Staff Attendance:




Dates of the Monitoring Period:         From:                                    To:


QI Indicators:
Hours of Operation                              Explanation of the procedure                     Overall impression of visit
Convenience of the facility location            Questions answered                               Willingness to return
Cleanliness of the facility                     Friendly and helpful to you                      Likelihood of referring to others
Waiting time in the reception area              Knowledgeable and professional
Comfort while waiting                           Modesty respected
                                                Confidentiality respected (HIPPA)

                                       Great      Good         OK         Fair           Poor
Measurement (Scale):
                                         5         4            3          2              1

Data Sampling Method:




Predicted Threshold Limits:        Percentage of "Poor" Responses
Hours of Operation                 0%        Explanation of the procedure              0%        Overall impression of visit         0%
                                   0%
Convenience of the facility location         Questions answered                        0%        Willingness to return               0%
Cleanliness of the facility        0%        Friendly and helpful to you               0%        Likelihood of referring to others   0%
Waiting time in the reception area0%         Knowledgeable and professional            0%
Comfort while waiting              0%        Modesty respected                         0%
                                             Confidentiality respected (HIPPA)         0%

Threshold Level Achieved:
Hours of Operation                 #DIV/0!      Explanation of the procedure           #DIV/0!   Overall impression of visit         #DIV/0!
                                   #DIV/0!
Convenience of the facility location            Questions answered                     #DIV/0!   Willingness to return               #DIV/0!
Cleanliness of the facility        #DIV/0!      Friendly and helpful to you            #DIV/0!   Likelihood of referring to others   #DIV/0!
Waiting time in the reception area#DIV/0!       Knowledgeable and professional         #DIV/0!
Comfort while waiting              #DIV/0!      Modesty respected                      #DIV/0!
                                                Confidentiality respected (HIPPA)      #DIV/0!

Analysis of Data: (See attached "Results" worksheet)
Staff Discussion:




Corrective Action/Improvement Plan:




Other Comments:




Re-evaluation Date:

Reported by                           Date:

Reviewed by                           Date:

				
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posted:10/12/2011
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