• Conducted on


  • We are interested in how your day is going and what e can do to help; do you have time to answer a few questions?

Staff Information

  • Names of Employees

  • HIM

  • Business Office

  • Patient Access

  • Specialty Clinics

  • Nutrition Services

  • EVS

  • Facilities

  • EMS

  • IT

  • Lab

  • Radiology

  • Rehab

  • Respiratory

  • Med/Surg

  • Surgery

Summary of Staff Visit

  • What's working well?

  • What's not going well; what keeps you up at night concerning our patient care or safety?

  • Do you have all the resources / tools you need to do an exceptional job; if not, what would help you provide better patient care?

  • How can we help you to better perform / succeed in your job so we always provide outstanding patient care

  • Good morning/afternoon, my name is ____________ and I am from administration. I am visiting with you today because I am interested in finding out how we are doing during your hospital stay. Would you mind answering a few questions?

Patient Demographic

  • Emergency Room

  • RLC

  • 101

  • 102

  • 103

  • 104

  • 105

  • 106

  • 10

  • 108

  • 109

  • 110

  • 111

  • 112

  • FCC

Summary of Patient Visit

  • Is our staff responding to you when you call for help and checking in to see if you need anything?

  • Are we managing your pain appropriately?

  • Do you have any concerns you would like to discuss?

Before Leaving Patient's Room

  • Within the next two weeks you will receive a satisfaction survey from Healthstream. This survey is an important tool for Anderson County Hospital to share your patient experience with our leaders and staff. Receiving the highest score is the goal of our hospital leadership, staff and caregivers. Can we count on you to complete and return the survey?

  • Is there anything I can do for you before I leave, I have time?

  • Give patient your business card and contact number.

Leadership Information

  • Leader's Name

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.