Hospice Care Feedback Form

Gather feedback from patients and their families about the quality of hospice care received.

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About this template

This Hospice Care Feedback Form is designed to collect feedback from patients and their families regarding the quality of hospice care received. By gathering valuable insights and suggestions, healthcare providers can make improvements to enhance the patient experience and provide better care.

The form begins with a thank you message, expressing appreciation for choosing their hospice care services. It also emphasizes the importance of feedback in improving the services provided. The introductory message helps to incentivize patients and their families to complete the form.

The first question in the form is a Likert scale question, asking respondents to rate the overall quality of the hospice care received on a scale of 1 to 5. This question provides an immediate assessment of the patient’s satisfaction level.

The form includes an open-ended question asking for specific feedback or comments regarding the care received. This allows respondents to provide more detailed information about their experience.

Next, there is a conditional question that appears only if the overall quality rating is 3 or lower. This question asks respondents if there are any aspects of the service that could be improved. By focusing on areas that need enhancement, healthcare providers can target specific improvements.

A thumbs rating question follows, inquiring whether the staff communicated effectively and compassionately. This provides insight into the patient’s perception of the staff’s communication skills and empathy.

The form continues with another Likert scale question, asking respondents to rate the cleanliness and comfort of the hospice facility. This question evaluates the physical environment’s impact on the patient’s experience.

Another thumbs rating question appears, asking if the staff provided emotional support to the patient and their family. This question assesses the effectiveness of emotional care, which is crucial in a hospice setting.

A Customer Satisfaction (CSAT) scale question is included to determine whether the respondent would recommend the hospice care services to others. This question provides an indication of the likelihood of referral, which is a significant measure of satisfaction.

The form concludes with an open-ended question allowing respondents to share any additional comments or experiences they would like to express. This provides an opportunity for respondents to provide further insights or suggestions.

Finally, the form ends with a thank you message, expressing gratitude for the feedback provided and emphasizing its importance in enhancing services. The closing message completes the feedback loop and leaves respondents with a positive impression of their participation.

By utilizing this Hospice Care Feedback Form, healthcare providers can effectively collect feedback, identify areas for improvement, and enhance the overall experience and quality of care provided to patients and their families.

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