Audit

Patient Demographic

Patient Name

Patient Number

Summary of Visit

What was working well today?

Are there any specific individuals whom we should be recognizing and what made them notable?

Are there any physicians whom we should be recognizing and what made them notable?

Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address and resolve the issues?

Any suggestions on how to enhance / improve service delivery?

Quarterly Focus

Within the next two weeks you will receive a satisfaction survey from NRC Picker. This survey is an important tool for Einstein Medical Center Montgomery to share your patient experience with our leaders and peers in the acute hospital community. 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?

Did EMCM meet your needs in a manner that would give you confidence to respond to the NRC Picker satisfaction survey with the highest score? If no, why?

Do you have any recommendations to improve the issues you identified?

Patient 2

Patient Demographic

Patient Name

Patient Number

Summary of Visit

What was working well today?

Are there any specific individuals whom we should be recognizing and what made them notable?

Are there any physicians whom we should be recognizing and what made them notable?

Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address and resolve the issues?

Any suggestions on how to enhance / improve service delivery?

Quarterly Focus

Within the next two weeks you will receive a satisfaction survey from NRC Picker. This survey is an important tool for Einstein Medical Center Montgomery to share your patient experience with our leaders and peers in the acute hospital community. 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?

Did EMCM meet your needs in a manner that would give you confidence to respond to the NRC Picker satisfaction survey with the highest score? If no, why?

Do you have any recommendations to improve the issues you identified?

Patient 3

Patient Demographic

Patient Name

Patient Number

Summary of Visit

What was working well today?

Are there any specific individuals whom we should be recognizing and what made them notable?

Are there any physicians whom we should be recognizing and what made them notable?

Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address and resolve the issues?

Any suggestions on how to enhance / improve service delivery?

Quarterly Focus

Within the next two weeks you will receive a satisfaction survey from NRC Picker. This survey is an important tool for Einstein Medical Center Montgomery to share your patient experience with our leaders and peers in the acute hospital community. 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?

Did EMCM meet your needs in a manner that would give you confidence to respond to the NRC Picker satisfaction survey with the highest score? If no, why?

Do you have any recommendations to improve the issues you identified?

Patient 4

Patient Demographic

Patient Name

Patient Number

Summary of Visit

What was working well today?

Are there any specific individuals whom we should be recognizing and what made them notable?

Are there any physicians whom we should be recognizing and what made them notable?

Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address and resolve the issues?

Any suggestions on how to enhance / improve service delivery?

Quarterly Focus

Within the next two weeks you will receive a satisfaction survey from NRC Picker. This survey is an important tool for Einstein Medical Center Montgomery to share your patient experience with our leaders and peers in the acute hospital community. 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?

Did EMCM meet your needs in a manner that would give you confidence to respond to the NRC Picker satisfaction survey with the highest score? If no, why?

Do you have any recommendations to improve the issues you identified?

Patient 5

Patient Demographic

Patient Name

Patient Number

Summary of Visit

What was working well today?

Are there any specific individuals whom we should be recognizing and what made them notable?

Are there any physicians whom we should be recognizing and what made them notable?

Did you receive any negative feedback from patients, visitors, employees, or physicians? If so, how do you plan to address and resolve the issues?

Any suggestions on how to enhance / improve service delivery?

Quarterly Focus

Within the next two weeks you will receive a satisfaction survey from NRC Picker. This survey is an important tool for Einstein Medical Center Montgomery to share your patient experience with our leaders and peers in the acute hospital community. 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?

Did EMCM meet your needs in a manner that would give you confidence to respond to the NRC Picker satisfaction survey with the highest score? If no, why?

Do you have any recommendations to improve the issues you identified?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.