Patient Experience Survey — Fifteen Questions
Short enough to complete at discharge, comparable across facilities, built from validated items: respect, information, involvement, pain, medicines, discharge, environment, and the one that matters — would you recommend us?
What it is
A fifteen-item patient experience survey with response scales, adapted from the public-domain HCAHPS/CAHPS item bank and the NHS Friends and Family Test: communication with nurses and doctors, responsiveness, pain, medicines explained, discharge information, cleanliness and quiet, respect and dignity, overall rating and recommendation — with the scoring and the quarterly report line.
Where to use it
Given at discharge (paper, QR or SMS) to every patient or a systematic sample; results quarterly to the Patient Council and the board; published in the annual summary. Evidence for: Standard 2 — patient experience measurement; Governance — feedback; Patient Voice. Evidence for: Standard 2 — patient experience measurement; Governance — feedback; Patient Voice.
Translate and adapt
English master edition. Georgian and other translations are added as they are clinically reviewed. Any facility may translate, add its logo and adapt wording to local practice — keeping the ASF block, the source attribution and the licence line on the sheet. Clinical thresholds and drug doses must be confirmed against national protocols before use.
The same code is printed on the tool itself. Scan it in any facility to reach this page.
Price List and Written Estimate — Template
Annual Public Report — Outline for an Accredited Organization
Print to share.
