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Free form: Referring physician satisfaction survey

Hospitalist Leadership Connection, May 25, 2010

Ideally, hospitalist programs systematically monitor all forms of communication to referring physicians to gain feedback about the effectiveness of the program. However, such an endeavor can be difficult and time and resource consuming. As a result, it may be more practical to gather periodic feedback from referring physicians in the form of physician satisfaction surveys. Remember, feedback can be gathered in less formal ways as well, such as though periodic phone calls. Below is a sample referring physician satisfaction survey to customize.

Referring physician satisfaction survey

Your satisfaction with the hospitalist services provided at [name of hospital] is important to us. To help us serve you better in the future, please select the answer that best describes how you feel about our services.

1.    Are you satisfied with the quality of medical care delivered to your patients at [name of hospital]?
Y or N
If not, please explain.

2.    Do you routinely distribute the [name of hospital] inpatient service brochure to your patients? Y or N
If not, please explain.

3. When called upon, are you willing to assist [name of hospitalist service] in the management of your difficult hospitalized patient? Y or N
If not, please explain.

4. Do your patients seem satisfied with the overall care delivered by [name of hospitalist service] during their hospital stays? Y or N
If not, please explain.

5. Your overall satisfaction with [name of hospitalist service] is:
Excellent, Very good, Good, Fair, Poor

Please provide any suggestions for improvement in the comments section of this form.

The above form is adapted from Tools and Strategies for an Effective Hospitalist Program, published by HCPro, Inc.
 

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