Inpatient Questionnaire

ACCESSIBILITY:

1. How easy was it for you and your visitors to find your way to the Hospital?:

If you encountered any problems – please write the details, or suggest ways we can improve the signs.:

2. Are the signs in the Hospital adequate – that is, how easy was it for you and your visitors to find the right room/department?:

If you encountered any problems – please write the details, or suggest ways we can improve the signs:

3. Do you have a problem with your mobility (ie you use a wheelchair, walking stick, frame etc):

If you answered “yes”, Did you find the physical access to and within the Hospital adequate for your needs – that is – sufficient ramps, automatic doors etc.:

4. Do you have any suggestions on how we can improve access to the Hospital? (eg more ramps, wheelchairs etc):

5. Are the Services provided by the Hospital adequate for your needs – that is, do you have go to another hospital for special treatment?:

If you answered no to Qu. 5, please indicate other services you require:

6. Are the visiting hours appropriate?:

If you answered no to Qu. 6, please make a suggestion:

7. Are the Reception hours appropriate?:

If you answered no to Qu. 7, please make a suggestion:

ADMISSION PROCESS:

8. When you were admitted to the Hospital, how would you rate the following:

8a. Waiting time from presenting to Hospital and being taken to your room:

8b. Manner and courtesy of ward staff when taken to your room:

9. YOUR RIGHTS AS A PATIENT:

9a. Did you receive a copy of “Your rights and responsibilities”:

9b. Did you understand the booklet?:

9c. Do you feel your rights were respected while in Hospital?:

CARE AND TREATMENT:

10. In relation to your care and treatment, how would you rate the following?:

10a. Attitude of the nursing staff?:

10b. Attitude of cleaning / catering staff?:

10c. Information given regarding your care and treatment, including possible alternatives:

10d. Recognition of your opinions regarding your care and involving you in planning your care:

10e. Involving your family / carer about your care and treatment:

10f. Respect for your privacy:

11. In relation to your condition, how would you rate the following:

11a. Information given to you and / or your carer about your diagnosis (illness) and prognosis (outcome):

11b. Information regarding all tests to be carried out:

11c. Information about treatments, including medication:

PHYSICAL FACILITIES:

12. In relation to the physical facilities – how would you rate the following?:

12a. General condition and appearance of your room:

12b. Overall cleanliness of your room:

12c. Cleanliness of the toilet and shower:

12d. Did you feel you (and your belongings) were safe while you were in Hospital:

MEALS:

13. In relation to your meals how would you rate the following:

13a. Quality of the food:

13b. Range and appeal of the menu:

DISCHARGE ARRANGEMENTS:

14. Were you given enough notice regarding your expected discharge date?:

15. How would you rate the way your discharge arrangements were handled?:

16. How appropriate was your date of discharge?:

17. Would you recommend this Hospital to your family or friends if they needed Hospital care?:

If you would not recommend this hospital – is there a reason?:

18. Was there anything about your experience at the Mallee Health Service that was better than expected?:

19. Was there anything about your stay at the Mallee Health Service that was not as good as you expected?:

20. We would welcome any other comments or suggestions you may like to offer: