MHS Facilities Design Survey

OMB CONTROL NUMBER: 0704-0553

OMB EXPIRATION DATE: 05/31/2025

2024 Facilities Design Survey

NOTE: Prior to the Spouse Survey, interviewer will have surveyed the Active Duty Service Member on the same questions and asked them if they have a spouse that is available to respond as well.

SPOUSE SURVEY

RESPONDENT (SPOUSE) on phone  Hello, we are conducting a short survey for the Defense Health Agency to get feedback from active duty patients who have been hospitalized within the past year and their spouses. Our questions are about features of patients’ rooms and changes that can be made to make hospital stays more comfortable and convenient. We want to understand what features of hospital design are important to patients and visitors. Our questions take less than 10 minutes.

This survey is confidential, and your privacy is protected. All information that would let someone identify you or your family will be kept private. Zogby Analytics will not share your personal information with anyone without your written permission, and your information will be protected from re-disclosure without your authorization. Your participation is voluntary, you do not have to complete this survey if you don’t want to. You may also skip any question you don’t want to answer. If you choose not to participate, or answer all the questions, it will not affect the health care you get or any services you receive. You may choose to revoke your authorization to participate in this survey at any time, including up to the end of this study. If you want to know more about this study, please call 315-624-0200 ext. 255. To verify the legitimacy of this survey, you can access the TRICARE web site [if requested: http://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Health-Care-Program-Evaluation/MHS-Patient-Satisfaction-Surveys] and click on Current Active Surveys. You can locate the survey by name or by its License Number [if requested: 0704-0553.]

AGENCY DISCLOSURE NOTICE

The public reporting burden for this collection of information, 0704-0553, is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

Your participation in the survey is voluntary, and there are no repercussions if you choose not to participate. Your answers will be kept confidential. OK?

Interviewer Check:

Respondent is:

1. Active Duty Service member

2. Spouse of Active Duty Service member

I’m going to ask you questions on the importance to you of certain features of hospital patients’ rooms. When you are thinking about how important these features are to you, please keep in mind that a facility may have a limited budget and may not be able to implement all of these features. Please try to rank a feature as Important or Very Important only if you feel strongly that a hospital room must include this feature.

For each question, please tell me whether the feature is Very Unimportant, Unimportant, Neither Unimportant nor Important, Important, or Very Important. Ready?

S1. How important was it for you to be able to control the temperature in your spouse’s hospital room? Would you say: Very Unimportant, Unimportant, Neither Unimportant nor Important, Important, or Very Important? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S2. How important was it for you to be able to control the lighting in your spouse’s hospital room (such as curtains or blinds and overhead lights)? Would you say: Very Unimportant, Unimportant, Neither Unimportant nor Important, Important, or Very Important? (Do Not Read Choices)

6. Very Unimportant

7. Unimportant

8. Neither Unimportant nor Important

9. Important

10. Very Important

Interviewer Note: from here on out, only repeat the “Very Unimportant, Unimportant, Neither Unimportant nor Important, Important, Very Important” phrase if the respondent seems unable to recall it.

S3. How important to you is having a bathroom that is easily accessible in your spouse’s hospital room? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S4. How important to you is having cell phone coverage and Wi-Fi access in your spouse’s hospital room? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S5. How important to you is having amenities to help reduce noise in your hospital room (such as earplugs, remote control to reduce volume of TV, closed doors to the hallway) in your spouse’s hospital room? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S6. How important to you is having a comfortable family area in your room where visitors or loved ones could spend the night during your spouse’s hospital stay? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S7. How important to you is having access to a family lounge with amenities (e.g., microwave, dining table, computer access, toilet/shower) during your spouse’s hospital stay? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S8. How important to you is having clear signage to help you navigate through the facility during your spouse’s hospital stay? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

S9. How important to you is having availability of parking near the facility during your spouse’s hospital stay? (Do Not Read Choices)

1. Very Unimportant

2. Unimportant

3. Neither Unimportant nor Important

4. Important

5. Very Important

Lastly, I am going to read you a statement. Please tell me if you Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, or Strongly Disagree with the statement.

S10. The signage (including posters and fliers) allowed me to easily navigate the facility during my spouse’s hospital stay. 

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. Strongly disagree

Thank you: Those are all of our questions. Thank you for your help.

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