Surgery Patient Experience Survey

We would appreciate your feedback regarding your recent surgery. We want tounderstandyourcare experiencebefore and after surgery. The information will help us evaluate and improve the quality of services we provide at Providence Health Care.

Please help us by taking a few moments to complete this survey. There is room foradditional comments on the reverse. Return the questionnaire in the envelope provided.

The following 3 questions are optional. The information is for statistical purposes only.

A. Year of birth: ______B. Gender: Female Male Transgender

C. Did you have someone to help you at home after your surgery? YES NO

Please rank each statement by circling the number that best describes your care experience. If you have comments related to astatement, check the “see comments” box and explain on the back of the page.
Strongly agree / Agree / Disagree / Strongly disagree / Does not apply / See Comments
  1. I received information from the patient navigator that helpedme prepare for my surgery and post-op care.
/ 4 / 3 / 2 / 1 / N/A
  1. The patient navigator helped address concerns I had about my surgery.
/ 4 / 3 / 2 / 1 / N/A
  1. The calls from the patient navigator, before and after surgery were helpful.
/ 4 / 3 / 2 / 1 / N/A
  1. Meeting(s) with the patient navigator improved my surgical experience.
/ 4 / 3 / 2 / 1 / N/A
  1. I would recommend having a patient navigator for other surgical patients.
/ 4 / 3 / 2 / 1 / N/A
  1. The Surgical Daycare staff were caring and attentive to my needs.
/ 4 / 3 / 2 / 1 / N/A
  1. TheOperating Room staff were caring and attentive to my needs.
/ 4 / 3 / 2 / 1 / N/A
  1. After mysurgery, pain was kept at a level that was acceptable to me.
/ 4 / 3 / 2 / 1 / N/A
  1. After mysurgery, if I experienced nausea or vomiting, it was kept to a level that was acceptable to me.
/ 4 / 3 / 2 / 1 / N/A
  1. After my surgery, I was able to get my questions answered adequately by members of the healthcare team.
/ 4 / 3 / 2 / 1 / N/A
  1. The Surgical Unit staff werecaring and attentive to my needs.
/ 4 / 3 / 2 / 1 / N/A
  1. I received enough information to care for myself and felt ready to go home when I was discharged.
/ 4 / 3 / 2 / 1 / N/A
  1. After discharge, I knew whom to contact if I had a question or concern.
/ 4 / 3 / 2 / 1 / N/A
  1. My surgical experience matched what I understood it would be.
/ 4 / 3 / 2 / 1 / N/A

Comments:

What was the most positive aspect of your care?

What is one change you would recommend we make to improve the care experience for future patients?

If you have additional comments or questions,please contact:

Stephen Parker, Clinical Nurse Specialist -Surgery

Phone: 604-682-2344 - local 66591

Email:

Thank you.

Page 1 of 2 Mar 21 2013 Please complete both sides.