CFI 143 VA Inpatient questionnaire

American Customer Satisfaction Index VHA Inpatient Veterans Affairs: Veterans Health Administration

PROG. NOTE: Move in CONTACT NAME from sample

[CONTACT NAME]: FNAME LNAME FROM SAMPLE

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May I speak with (RESTORE CONTACT NAME)?

Hello, I'm (NAME) calling on behalf of the CFI Group. We are conducting research on how satisfied users are with services provided by federal government agencies and private companies as part of the American Customer Satisfaction Index. Today I want to ask you about services you may have received as an inpatient from the VA Medical Center. The purpose of the research is to help the Veterans Health Administration improve its services to veterans. Your name will be confidential, and I will ask you only about products and services you have recently purchased and used. Your participation is voluntary and poses no foreseeable risk to you. You may stop at any time or skip any question you do not wish to answer. Your opinions are important because you have been chosen randomly to represent consumers across the United States and your responses will be added to a growing database of evaluations of customer satisfaction used by researchers, companies, and government agencies to improve the products and services provided to you, the consumer. This interview will take 8-10 minutes and is authorized by Office of Management and Budget Control No. 1505-0191.

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PROG. NOTE: TERMINATE SCREEN

Those are all of the questions I have for you. Thank you for your interest in this project.

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Now, I am going to ask you some questions about the VA Medical Center with which you have had experience as an inpatient.

Q1. Before you entered the VA Medical Center for inpatient care, you probably knew something about that VA Medical Center. Now think back and remember your expectations of the overall quality of the VA Medical Center. Please give me a rating on a 10 point scale on which "1" means your expectations were "not very high" and "10" means your expectations were "very high."

How would you rate your expectations of the overall quality of the VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Now, let's think about the information you received from caregivers at the VA Medical Center…

Q2. If you had concerns you needed answered, how clearly did your caregiver provide information to you in a way you could understand? Using a 10 point scale again on which “1” means “not at all clearly” and “10” means “very clearly,” how clearly did the VA Medical Center caregivers provide information to you in a way you could understand?

[RECORD NUMBER 1-10]

11 Had no concerns

DK

REF

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Q3. How clearly did doctors or nurses explain test results to you in a way you could understand? Using a 10 point scale again on which “1” means “not at all clearly” and “10” means “very clearly,” how clearly did the VA Medical Center doctors or nurses explain test results to you in a way you could understand?

[RECORD NUMBER 1-10]

DK

REF

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Now let’s talk about your physical comfort during your inpatient experience at the VA Medical Center…

Q4. How responsive was hospital staff when you used the call button? On a 10 point scale on which “1” means “not at all responsive” and “10” means “very responsive,” how responsive was hospital staff when you used the call button?

[RECORD NUMBER 1-10]

11 Never used call button

DK

REF

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Q5. To what degree did you feel you were treated with respect and dignity while in the hospital? On a 10 point scale on which “1” means “not at all treated with dignity and respect” and “10” means “very much treated with dignity and respect,” to what degree did you feel you were treated with respect and dignity while in the hospital?

[RECORD NUMBER 1-10]

DK

REF

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Q6. How courteous were your doctors? On a 10 point scale on which “1” means “not at all courteous” and “10” means “very courteous,” how courteous were your doctors?

[RECORD NUMBER 1-10]

DK

REF

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Q7. And how courteous were your nurses? On a 10 point scale on which “1” means “not at all courteous” and “10” means “very courteous,” how courteous were your nurses?

[RECORD NUMBER 1-10]

DK

REF

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Q10. Please consider all your experiences in the past two years with inpatient care at the VA Medical Center. Using a 10 point scale, on which "1" means "not very high" and "10" means "very high," how would you rate the overall quality of inpatient care at the VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Satisfaction includes many things. Let's move on and talk about your overall satisfaction with the inpatient care at the VA Medical Center.

Q11. First, please consider all your experiences to date as an inpatient at the VA Medical Center. Using a 10 point scale on which “1” means “very dissatisfied” and “10” means “very satisfied,” how satisfied are you with that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Q12. Considering all of your expectations, to what extent has the inpatient care at the VA Medical Center fallen short of or exceeded your expectations? Using a 10 point scale on which "1" now means "falls short of your expectations" and "10" means "exceeds your expectations," to what extent has that VA Medical Center fallen short of or exceeded your expectations?

[RECORD NUMBER 1-10]

DK

REF

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Q13. Forget the VA Medical Center for a moment. Now, I want you to imagine an ideal medical center providing inpatient care. (PAUSE) How well do you think the VA Medical Center compares with that ideal medical center? Please use a 10 point scale on which "1" means "not very close to the ideal," and "10" means "very close to the ideal."

[RECORD NUMBER 1-10]

DK

REF

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Next, I want you to think about any communication you may have had with the VA Medical Center regarding complaints about your inpatient care experience.

Q14. Have you complained to the VA Medical Center within the past year?

1 Yes

2. No

DK

REF

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{IF Q14 = 1, ASK Q14A – 14B; OTHERWISE GO TO Q15}

Q14A. How well, or poorly, was your most recent complaint handled? Using a 10 point scale on which “1” means “handled very poorly” and “10” means “handled very well,” how would you rate the handling of your complaint?

[RECORD NUMBER 1-10]

DK

REF

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Q14B. How difficult or easy was it to make your most recent complaint? Using a 10 point scale on which “1” means “very difficult” and “10” means “very easy,” how difficult or easy was it to make a complaint?

[RECORD NUMBER 1-10]

DK

REF

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Q15. How likely is it that you will use the VA Medical Center again in the future when you need inpatient medical care? On a 10 point scale on which “1” means “very unlikely” and “10” means “very likely,” how likely is it that you will use the VA Medical Center again?

[RECORD NUMBER 1-10]

DK

REF

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Q16. If asked, how willing would you be to say positive things about inpatient care at the VA Medical Center to other veterans? On a 10 point scale on which “1” means “not at all willing” and “10” means “very willing,” how willing would you be to say positive things about that VA Medical Center?

[RECORD NUMBER 1-10]

DK

REF

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Q17. What is the primary means you used to obtain services from the VA Medical Center where you were recently an inpatient? (READ CODES 1-6 IF NECESSARY; ACCEPT ONE MENTION)

1. E-mail

2. Internet/World Wide Web

3. Telephone call

4. Visit to medical center

5. Written communication

6. Some other means

7. Not applicable/do not obtain services from this center

DK

REF

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Q18. Was your recent hospital stay an emergency or planned in advance?

1. Emergency

2. Planned in advance

DK

REF

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Now, we need to ask a few demographic questions for the ACSI consumer profile…

QD1. What is your age, please?

[RECORD NUMBER OF YEARS 1-150]

DK

REF

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QD2. What is the highest level of formal education you completed? (READ CODES 1-5)

1. Less than high school

2. High school graduate

3. Some college or associate degree

4. College graduate

5. Post-Graduate

DK

REF

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QD3. Are you of Hispanic, Latino or Spanish origin?

1. Yes

2. No

DK

REF

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QD4. Do you consider your race(s) as: (READ CODES 1-5, ACCEPT UP TO 5 MENTIONS)

1. White

2. Black or African American

3. American Indian or Alaska Native

4. Asian

5. Native Hawaiian or other Pacific Islander

6. Other race

DK

REF

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QD5. What was your total annual family income in 2005? (READ CODES 1-7 AS NECESSARY) (READ IF NECESSARY: Before taxes)

1. Under $20,000

2. $20,000 but less than $30,000

3. $30,000 but less than $40,000

4. 40,000 but less than $60,000

5. $60,000 but less than $80,000

6. $80,000 but less than $100,000

7. $100,000 or more

DK

REF

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QD6. Gender (By Observation)

1. Male

2. Female

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8