Assessing the satisfaction of your patients and taking improvement actions based on their feedback is the easiest, yet most effective way of improving the service quality of your hospital. This tool can be used as a reference to develop a relevant questionnaire for your hospital
Hospital Patient Experience and Satisfaction Assessment Questionnaire
A) Demographic Information:
A.1. Age: __________
A.2. Gender: __________
A.3. Admission Date: __________
A.4. Discharge Date: __________
A.5. Department/Unit: __________
B) Experience with Admission Process:
B.1. How would you rate the efficiency of the admission process?
- Very efficient
- Somewhat efficient
- Neutral
- Somewhat inefficient
- Very inefficient
B.2. Were you provided with clear information about your condition and the planned treatment upon admission?
- Yes
- Somewhat
- No
C. Hospital Stay
C.1 How comfortable was your room and bed?
- Very comfortable
- Comfortable
- Neutral
- Uncomfortable
- Very uncomfortable
C.2 How would you rate the cleanliness of the hospital facilities, including your room?
- Very clean
- Clean
- Neutral
- Unclean
- Very unclean
C.3 How would you rate the quality of the food provided during your stay?
- Excellent
- Good
- Fair
- Poor
- Very poor
C.4. Were your dietary requirements and preferences considered and accommodated?
- Always
- Often
- Sometimes
- Rarely
- Never
D. Communication with Medical Staff:
D.1 How well did the doctors, nurses, and other medical staff communicate with you regarding your treatment?
- Very well
- Well
- Neutral
- Poorly
- Very poorly
D.2. Did you feel involved in decisions about your care and treatment?
- Always
- Often
- Sometimes
- Rarely
- Never
- Very responsive
- Responsive
- Neutral
- Unresponsive
- Very unresponsive
E. Treatment and Care
E.1. How would you rate the quality of medical care you received?
- Excellent
- Good
- Fair
- Poor
- Very poor
E.2. How effectively were your pain and discomfort managed?
- Very effectively
- Effectively
- Neutral
- Ineffectively
- Very ineffectively
E.3. Were you provided with clear instructions upon discharge for managing your care at home?
- Yes
- Somewhat
- No
F. Overall Experience:
F.1 How likely are you to recommend our hospital to friends and family?
- Very likely
- Likely
- Neutral
- Unlikely
- Very unlikely
F.2. What did you appreciate most about your stay?
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F.3. Please provide any other comments or suggestions you have about your experience in our hospital
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(Thank You, Very much for your time and feedback)
