Patient Experience of Care Script

IHS_Patient Exp Script12.9.2016.docx

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

Patient Experience of Care Script

OMB: 0917-0036

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Indian Health Service

Patient Experience of Care Pilot


Survey Script:

[During the times designated for survey collection a staff member will smile and speak to arriving patients:] “Hello, while you are signing in, I’d like to tell you about something new at our clinic. We are participating in a program to understand more about patient experiences here. Would you be willing to take a few minutes before you leave today to answer a brief survey that is designed to help our clinic make improvements to meet your care expectations? We would appreciate hearing your ideas so that we know what we can do better. Your answers are confidential and will be used by our quality improvement team to understand and act on improvements.


Here is a brochure that will explain the program and give you more information so you can decide if you would like to participate.”


[At check out: The staff member smiles and says:] “Thank you for coming in today. When you checked in, did someone talk to you or give you a brochure about the patient experience survey program we are participating in? Do you have any questions that I can answer now? Are you interested in taking our short, confidential survey now?


[If the patient answers “yes”]: “Thank you. We are using this tablet device to record your answers. It is easy to use and only takes a few minutes. Your responses are anonymous because there is no way to link your answers back to you. You are welcome to ask me any questions at any point. Using the touch screen, please respond to the questions displayed on the tablet device by choosing the answer that best describes the care you received today. Any specific ideas or suggestions you would like to add in the comment section are helpful.


Here is the tablet. (The staff member hands the tablet to the patient.) “Please hand it back to me when you are finished.”


Upon competition, the staff member, says, “Thank you for completing our survey and for coming in today.”


[If the patient declines to take the survey and answers verbally or indicates through body language, a “no,” the staff member smiles and says:] “That is perfectly okay. The survey is completely voluntary. If on a future visit you have some ideas or thoughts on how we can do better, we would appreciate your participation because what you think is very important to us.”



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