Measurement tool 3: Patient experience survey Step 1: Survey your patients. Purpose: The purpose of this survey is to measure patient satisfaction and understand the patient experience with the panel management process. Instructions: Distribute this survey to patients at time points: (1) at least one week before starting the new panel management process, which will serve as baseline data; (2) 12 weeks after implementation and (3) 24 weeks after implementation. Administer the survey to all patients on the same day of the week each time (e.g., sample all patients with Tuesday appointments at each time point). Ask a member of the team to provide the survey to every patient after their visit with the provider and identify a place for patients to anonymously submit their completed survey. To obtain meaningful results, aim to collect 30 survey responses per time point. Use survey results to identify opportunities to improve performance. The shaded gray cells have been included to guide you in transferring data through this multi-step tool. Patient Survey Survey number (to be filled out by clinic staff): Date of Survey: How much do you agree or disagree with the following statements? Please circle your answer. 1. I feel good about my visit. 1 Strongly 5 Strongly 2 Disagree 3 Neutral 4 disagree agree 2. I felt that my provider 1 Strongly 5 Strongly (physician, NP, or PA) was 2 Disagree 3 Neutral 4 Agree disagree agree prepared for my visit. 3. I felt that I received comprehensive care that is, 1 Strongly 5 Strongly – 2 Disagree 3 Neutral 4 Agree the care team covered all of disagree agree my health-related needs. 4. My care team spoke with me 1 Strongly 5 Strongly 2 Disagree 3 Neutral 4 Agree about preventive and chronic disagree agree care needs today, such as
Measurement tool 3: Patient experience survey Step 1: Survey your patients. Purpose: The purpose of this survey is to measure patient satisfaction and understand the patient experience with the panel management process. Instructions: Distribute this survey to patients at time points: (1) at least one week before starting the new panel management process, which will serve as baseline data; (2) 12 weeks after implementation and (3) 24 weeks after implementation. Administer the survey to all patients on the same day of the week each time (e.g., sample all patients with Tuesday appointments at each time point). Ask a member of the team to provide the survey to every patient after their visit with the provider and identify a place for patients to anonymously submit their completed survey. To obtain meaningful results, aim to collect 30 survey responses per time point. Use survey results to identify opportunities to improve performance. The shaded gray cells have been included to guide you in transferring data through this multi-step tool. Patient Survey Survey number (to be filled out by clinic staff): Date of Survey: How much do you agree or disagree with the following statements? Please circle your answer. 1. I feel good about my visit. 1 Strongly disagree 2 Disagree 3 Neutral 4 5 Strongly agree 2. I felt that my provider (physician, NP, or PA) was prepared for my visit. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 3. I felt that I received comprehensive care – that is, the care team covered all of my health-related needs. 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree 4. My care team spoke with me about preventive and chronic care needs today, such as 1 Strongly disagree 2 Disagree 3 Neutral 4 Agree 5 Strongly agree
10.1001stepsforward.2017.0093supp9.docx