Template

Patient Survey Template for HCAHPS

by Shivani Gupta, from the Community

This digital patient survey template is based on the HCAHPS survey and helps hospitals measure patient experience and care quality. It covers nurse and doctor communication, responsiveness, cleanliness and quietness, pain management, medication education, discharge planning, overall hospital rating, and likelihood to recommend. Conditional logic shows only relevant questions, and failed items highlight priority areas for improvement during and after inpatient stays.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Patient Survey Template
This patient survey template based on the HCAHPS Survey is designed to measure the quality of hospital care. Administered by hospital staff, this digital survey uses conditional logic to hide or display relevant succeeding questions based on precedent answers. This template utilizes failed items to help determine which areas in patient care need priority.
by SafetyCulture
Downloads: 100+
Get
Template
ACH Leadership Rounding Template
This ACH Leadership Rounding template supports hospital leaders during staff and patient rounding. It captures staff details across departments, what is working well, issues affecting patient care and safety, and resource needs. The patient section checks responsiveness, pain management, and concerns, and includes a survey reminder. Use it to standardize leadership rounds, surface improvement opportunities, and enhance patient experience and clinical quality.
by ACH ACH, from the Community
Downloads: 10+
Get
Template
JCI Mock Survey Tools
Use these JCI mock survey tools to evaluate hospital readiness against Joint Commission International standards. The checklist covers International Patient Safety Goals, Access to Care and Continuity of Care, Patient and Family Rights, Assessment and Care of Patients, Patient and Family Education, and Management of Information. Verify patient identification, safe medication practices, hand hygiene, surgical safety, fall risk, consent, discharge, transfers, and documentation. Identify compliance gaps, standardize handovers, confirm critical results workflows, and ensure secure information management and record retention. Ideal for internal audits, staff training, and accreditation preparation.
by mohamed elgamal, from the Community
Downloads: 10+
Get
Template
Patient Sign in Sheet Template
Use this Patient Sign in Sheet Template to track patient attendance. This can help record information such as the time of appointment, assigned doctor, and time of patient's arrival. Use SafetyCulture to generate offline reports and track patient attendance.
by SafetyCulture
Downloads: 20+
Get

Patient Survey Template

This patient survey template based on the HCAHPS Survey is designed to measure the quality of hospital care. Administered by hospital staff, this digital survey uses conditional logic to hide or display relevant succeeding questions based on precedent answers. This template utilizes failed items to help determine which areas in patient care need priority.

by SafetyCulture

100+

Get

Template

ACH Leadership Rounding Template

This ACH Leadership Rounding template supports hospital leaders during staff and patient rounding. It captures staff details across departments, what is working well, issues affecting patient care and safety, and resource needs. The patient section checks responsiveness, pain management, and concerns, and includes a survey reminder. Use it to standardize leadership rounds, surface improvement opportunities, and enhance patient experience and clinical quality.

by ACH ACH, from the Community

10+

Get

Template

JCI Mock Survey Tools

Use these JCI mock survey tools to evaluate hospital readiness against Joint Commission International standards. The checklist covers International Patient Safety Goals, Access to Care and Continuity of Care, Patient and Family Rights, Assessment and Care of Patients, Patient and Family Education, and Management of Information. Verify patient identification, safe medication practices, hand hygiene, surgical safety, fall risk, consent, discharge, transfers, and documentation. Identify compliance gaps, standardize handovers, confirm critical results workflows, and ensure secure information management and record retention. Ideal for internal audits, staff training, and accreditation preparation.

by mohamed elgamal, from the Community

10+

Get

Template

Patient Sign in Sheet Template

Use this Patient Sign in Sheet Template to track patient attendance. This can help record information such as the time of appointment, assigned doctor, and time of patient's arrival. Use SafetyCulture to generate offline reports and track patient attendance.

by SafetyCulture

20+

Get

Patient Survey Template for HCAHPS

About author

You might also like

Patient Survey Template

ACH Leadership Rounding Template

JCI Mock Survey Tools

Patient Sign in Sheet Template

You might also like

Patient Survey Template

ACH Leadership Rounding Template

JCI Mock Survey Tools

Patient Sign in Sheet Template