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Journal of the Academy of Hospital Administration

Medical Documentation - Patient Satisfaction Document

Author(s): Reena Kumar*

Vol. 15, No. 1 (2003-01 - 2003-06)

Improved socio-economic status and easier access to medical care has led to high expectations and demands from the consumer of hospital services. Medical services at public and private hospitals have been under increasing strain to meet the expectations particularly because the medical care has come to the ambit of "service" under the "Consumer Protection Act." This has necessitated regular monitoring of the quality of services in the hospital by the management. Assessment of care adequacy must go beyond the usual measures of structure process and outcome variables to include consumer evaluation of quality as well, indeed, any evaluation of care outcomes may be incomplete without including outcomes as perceived by the patients. It has been suggested that patient satisfaction is a potentially important factor in health care as it may influence whether or not a patient seeks medical care complies with treatment and maintains a continuing relationship with the providers. In order to meet patient's expectations and to assess their satisfaction during their stay in hospital, patient feed back form has been developed, which is used as one of the Total Quality Management indicators and helps the management to improve the services to them.

For Patient admitted in General Wards

Dear Patients,

Kindly feel free to indicate your experience during your stay in the hospital. Please fill the following form and return it to the ward incharge.

Sister in charge

1. Did you get relief of your pain and suffering? Yes/No
2. Did the ward nurse tell you about the Do's and Don'ts of the hospital on your admission to the ward? Yes/No
3. During your hospital stay who made your hospital bed? Sister/Yourself
4. Were you provided with bed pans/urine pots by the hospital staff when required? Yes/No
5. Did the Doctor/Nurse ask you to purchase any medicines, surgical items like gloves, syringes etc.
when you were in hospital? Please indicate:
 
1. 3.  
2. 4.  
6. Did you have to pay any money anywhere in the hospital? Yes/No
1.If yes whom did you pay ______________________________  
2. ___________________ Yes/No
7. While in the hospital could you discuss your problems with your Doctors/Nurses? Yes/No
8. Are You satisfied with the information given to you by the Nurses/Doctors in the hospital? Yes/No
9. How did you find the quality of food?  
a) Good b) Satisfactory c) Poor  
Remarks if any:  
___________________________________________________________________________________________
___________________________________________________________________________________________
10. How do you rate the cleanliness of the hospital?  
a)Very Good
b) Good
c) Average
d) Poor
 
11. Do you have any complaints/suggestions?  
12. On your discharge were you explained about your follow up treatment at the time of discharge?  

N.B. This should be filled up at time of discharge

Name of the patient________________

Bed No. _______________

Ward _______________

* Senior Resident, Deptt. of Hosp. Admn., AIIMS.

For Patient admitted in the private ward only

Dear Sir/Madam,

In order to rationalise the utilisation of the limited number of rooms in the private ward and to provide best possible services, we welcome your suggestions on the Hospital services.

It will be appreciated if you share your experience by filling the following proforma so as to enable us to improve the services to the best possible extent.

Medical Superintendent

Name of the Patient:

Name of Treating Consultant:

Date of Admission:

Date of Discharge:

1. Did you face any difficulty for registration and admission in the private ward?  
Yes/No, If Yes; Please suggest measures to improve the same. Yes/No
__________________________________________________________________________________________
__________________________________________________________________________________________
2. On admission, were your received properly in the ward and given a brief about rules and regulation of the
hospital?
Yes/No
3. On your arrival in the room, what was the condition of the room in terms of:  
 

(Please indicate By )

i) Room well prepared Yes/No
ii) Linen properly washed laid and Adequate in quantity i.e. Bed Sheet, Pillow, Blankets Yes/No
iii) Toilets and washbasin cleaned Yes/No
iv) Geyser working Yes/No
v) Bucket mug, bathing stool provided Yes/No
vi) Tap and fitting working Yes/No
vii) Fridge, TV working Yes/No
viii) Air-conditioning working Yes/No
4. Was your treatment started in time? Yes/No
5. Did your doctor visit you regularly? Yes/No
6. Were you told and explained about your disease and treatment plan by the treating doctor? Yes/No
7. Were all the medicines given to you by your nurse in time? Yes/No
8. Did you face any difficulty while undergoing any test/investigation inside/outside ward? Yes/No
Any suggestion  
____________________________________________________________________________________________
_____________________________________________________________________________________________
9. Was the nursing staff attentive and sympathetic to you, whenever you approached them or sent for them? Yes/No
10. i) Did you have any problem with our services, like food, Housekeeping or non functioning of T.V. Fridge, Geyser or any other item in the ward Yes/No
ii) Was the bed linen changed regularly? Yes/No
iii) Was quality of linen and quality of wash of linen satisfactory? Yes/No
iv) Was the room cleaned, mopped, dusted regularly? Yes/No
v) Was bed pan/urinal, provided at bed side whenever asked for? Yes/No
vi) Was bed ban/urinal removed and washed after use? Yes/No
Any suggestion on above  
1. i) Was he food provided and well served and good to taste? Yes/No
ii) Was your request to modify diet like diabetic diet etc. was attended to? Yes/No
Any suggestion on above  
2. Were you informed by nursing staff in time, about hospital dues? Yes/No
3. i) Was your discharge summary and bill made in time? Yes/No
ii) Were you explained about advice at discharge about medicines to be taken, follow up etc. by doctor and nurse? Yes/No
4. Suggestions which you feel might help us in improving our services to match your expectations.  
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
15. Any comment on the services of the doctor in the hospital
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
16. Any comment on the services of the Nursing Staff.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
17. Any comment on the services of Housekeeping Staff.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Signature______________

Room No.______________

1. Did you face any difficulty for registration and admission in the private ward?  
Yes/No If Yes; Please suggest measures to improve the same. Yes/No
__________________________________________________________________________________________
__________________________________________________________________________________________
2. On admission, were your received properly in the ward and given a brief about rules and regulation of the hospital? Yes/No
3. On your arrival in the room, what was the condition of the room in terms of:  
 

(Please indicate By )

i) Room well prepared Yes/No
ii) Linen properly washed laid and Adequate in quantity i.e. Bed Sheet, Pillow, Blankets Yes/No
iii) Toilets and washbasin cleaned Yes/No
iv) Geyser working Yes/No
v) Bucket mug, bathing stool provided Yes/No
vi) Tap and fitting working Yes/No
vii) Fridge, TV working Yes/No
viii) Air-conditioning working Yes/No
4. Was your treatment started in time? Yes/No
5. Did your doctor visit you regularly? Yes/No
6. Were you told and explained about your disease and treatment plan by the treating doctor? Yes/No
7. Were all the medicines given to you by your nurse in time? Yes/No
8. Did you face any difficulty while undergoing any test/investigation inside/outside ward? Yes/No
Any suggestion  
____________________________________________________________________________________________
_____________________________________________________________________________________________
9. Was the nursing staff attentive and sympathetic to you, whenever you approached them or sent for them? Yes/No
10. i) Did you have any problem with our services, like food, Housekeeping or non functioning of T.V. Fridge, Geyser or any other item in the ward Yes/No
ii) Was the bed linen changed regularly? Yes/No
iii) Was quality of linen and quality of wash of linen satisfactory? Yes/No
iv) Was the room cleaned, mopped, dusted regularly? Yes/No
v) Was bed pan/urinal, provided at bed side whenever asked for? Yes/No
vi) Was bed ban/urinal removed and washed after use? Yes/No
Any suggestion on above  
11. i) Was he food provided and well served and good to taste? Yes/No
ii) Was your request to modify diet like diabetic diet etc. was attended to? Yes/No
Any suggestion on above  
12. Were you informed by nursing staff in time, about hospital dues? Yes/No
13. i) Was your discharge summary and bill made in time? Yes/No
ii) Were you explained about advice at discharge about medicines to be taken, follow up etc. by doctor and nurse? Yes/No
14. Suggestions which you feel might help us in improving our services to match your expectations.  
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
15. Any comment on the services of the doctor in the hospital
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
16. Any comment on the services of the Nursing Staff.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
17. Any comment on the services of Housekeeping Staff.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Signature______________

Room No.______________

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