THE LISTER HOSPITAL
c h e l s ea
Patient Feedback
A questionnaire about the quality
of our service for patients, their
carers, family and friends
Please complete every section of this form by ticking the appropriate box alongside
each question. Where sections or questions are not applicable please ignore.
Questionnaires will be analysed by external consultants and returned to the hospital.
Your rights to anonymity are fully covered under the data protection act and no
personal information will be released to any other party.
Commited to excellence
Your opinions make a difference
At the Lister Hospital we aim to provide the highest standards of care for every patient and
a quality service to our visitors. To help us measure our level of achievement we would be
grateful if you took a few moments to complete this questionnaire. We regard your opinions
and comments as extremely valuable and we use them to identify areas of success and
opportunities for improvement. Naturally, all observations will be treated in the strictest of
confidence unless you indicate otherwise.
Once completed, simply fold over and seal the flap on the reverse of this leaflet and hand
it to reception on, or prior to, your departure. Alternatively, should you need more time for
consideration, put it into any post box. No stamp is necessary as we have paid the postage.
Thank you in advance for your help and assistance.
James Barr
Hospital Director
Prior to your admission
Did you receive an information pack from the hospital? Yes No
If yes, did it give you all the information you needed? Yes No
If no, how could we have improved it?
Your Admission
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Please give your opinion of:
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The greeting on arrival (friendliness of reception staff)
Promptness of your admission
The way we explained your room facilities
The way we explained the nurse call system
The helpfulness of porters
Your overall impression of the admission process
How could we have improved your admission?
Your Consultant
Was the proposed course of treatment clearly explained to you?
Yes, completely Yes, to some extent No
Were you asked to give your consent to your proposed treatment?
Yes No Don’t know
Was the expected outcome clearly explained to you?
Yes, completely Yes, to some extent No
When asking your consultant important questions, did you get answers you could understand?
Yes, always Yes, sometimes No
I had no need to ask questions
Do you feel you received sufficient post operative information?
Yes No, I had no need of post operative information
Did you have confidence and trust in the doctors treating you?
Yes, always Yes, sometimes No
Your Nursing
When you had important questions to ask a nurse, did you get answers you could understand?
Yes, always Yes, sometimes No
I had no need to ask questions
Do you have confidence and trust in the nurses treating you?
Yes, always Yes, sometimes No
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Please give your opinion of:
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Fair
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How well we kept you informed
Individual attention given
The response to nurse call
Our awareness of your condition
The consistent standard of your nursing care
The way we anticipated your needs
The way we calmed your fears
Your overall impression of nursing care
How could we have improved your nursing care?
Please answer the following question only if you were in any pain:
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Exc
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The way we advised/prepared you for post operative pain
How well we assessed the level of your pain
The way we administered your medicine at the right time
How well we did everything we could to help control your pain
How could we have improved the way we managed your pain?
Professional Services
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How would you rate?
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Fair
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Physiotherapy Imaging (X-Ray)
RMO (Resident doctor) Pharmacy
Your Accommodation
Room no:
Were you ever bothered by noise? (tick all that apply)
No Yes, from other patients
Yes, from hospital staff Yes, from something else
If yes, was it…? Day Night
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How would you rate each of the following?
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Fair
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In room entertainment (TV/Radio etc.)
Temperature control
Bathroom facilities
Room facilities
Décor
Care of visitors
Friendliness / helpfulness of housekeeping/cleaning staff
Friendliness / helpfulness of maintenance staff
Your overall impression of accommodation
How could we have improved your accommodation?
Cleanliness
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How would you rate each of the following?
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Exc
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Cleanliness of your room
Cleanliness of your toilet / bathroom
Cleanliness of hospital public areas
As far as you know did doctors wash or clean their hands between touching patients?
Yes, always Yes, sometimes
No Don’t know / can’t remember
As far as you know did nurses wash or clean their hands between touching patients?
Yes, always Yes, sometimes
No Don’t know / can’t remember
Catering
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How would you rate each of the following?
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Variety / choice of food
Correctness of order
Promptness of service
Temperature of food
Quality of food service
Friendliness / helpfulness of catering staff
Overall impression of catering
How could we have improved your catering?
General Questions
Did you feel you were treated with respect and dignity while you were in hospital?
Yes, always Yes, sometimes No
Did you want to be more involved in decisions made about your care and treatment?
Yes, definitely Yes, to some extent No
If your family or someone else close to you wanted to talk to a doctor, did they have enough
opportunity to do so?
Yes, definitely Yes, to some extent
No No, family or friends were involved
If you had any scheduled tests, X-rays or scans were they performed on time?
Yes, always Yes, sometimes No
If you had any messages or calls, did we deal with them efficiently?
Yes, always Yes, sometimes No
If you had any financial queries, did we deal with them efficiently?
Yes, always Yes, sometimes No
If you had any other administrative queries, did we deal with them efficiently?
Yes, always Yes, sometimes No
Going Home
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How would you rate each of the following?
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Assistance with planning your departure
Speed of departure process
Convenience of departure time
Instructions for your aftercare
Your overall impression of the discharge procedure
Did a member of staff explain the medicines you were to take at home in a way you could understand?
Yes, completely Yes, to some extent
No I had no medicines/didn’t need an explanation
Were you advised of the possible side effects of your medication?
Yes, fully Yes, to some extent
No I didn’t need an explanation
Were you told who to contact if you had any questions after discharge? Yes No
How could we have improved your discharge?
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Overall
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Overall rating of quality of care
Overall rating of value for money
If you have visited us before do you think we are
Getting better Staying the same Getting worse
Would you recommend us? Yes No
About you
Date of admission?
Are you? Inpatient Day patient
Name of your consultant?
Is this your first visit to this hospital? Yes No
Are you? Male Female
How old are you? 16 or under 17-24 25-40 41-64 65+
On what basis did you receive treatment? Insured Self pay Embassy
NHS Other
What were the main influences on your choice of this hospital? (tick all appropriate)
GP Location Website
Insurance Company Advertisement Consultant
Previous Visit Personal Recommendation
Other (specify)
Additional Comments
Would you like to mention any staff by name who gave especially good service and say what
made them special?
Please tick and include your name and address below only if you would like a reply to
comments raised.
Please tick box and include your telephone number if you are prepared to participate
in a brief telephone survey.
Name: … …………………………………………………… Telephone: ……………………………
Address: … ………………………………………………………………………………………………
… ………………………………………………………………………………………………
The Lister Hospital
FREEPOST (TK 1900)
TWICKENHAM
Middlesex TW1 4BR
Chelsea Bridge Road
London SW1W 8RH
Ward code:
t 020 7730 7733 f 020 7824 8867
e [email protected] w www.thelisterhospital.com
