Overton Brooks VAMC - ENT Department Survey

OMB Control Number:  2900-0770

Estimated Burden:  5 minutes

Expiration Date:  09/30/2020

Overton Brooks VA Medical Center

ENT Department Evaluation

OMB No. 2900-0770
Estimated Burden: 5 minutes

Expiration Date: 9/30/2020

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 5 minutes. This includes the time it will take to follow instructions, gather the necessary facts, and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services, as well as customer expectations and desires. The results of this survey/evaluation will lead to improvements in the quality of service delivery by helping to shape the direction and focus of services and the patient experience. Participation in this survey is voluntary, and failure to respond will have no impact on benefits to which you may be entitled.

Overton Brooks VA Medical Center ENT Department Evaluation

All patients who obtain ENT care from the Overton Brooks VA Medical Center have a choice of whether to obtain care at Overton Brooks VA Medical Center or to be asked to be referred to an outside ENT at a location of their choice. This survey is to assess what aspects of our patient’s care at Overton Brooks VA Medical Center is most important to our patients.

Scales 0 – 10 (0 being not important, 10 being the most important)

1. How important to your choice of care is the Overton Brooks VA Medical Center as a whole?

0 1 2 3 4 5 6 7 8 9 10

2. How important to your choice of care is the location of the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

3. How important to your choice of care is the cost of the care at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

4. How important to your choice of care is the reimbursement to you for coming (travel pay) to the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

5. How important to your choice of care are the ancillary services offered (cafeteria, store, etc.) at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

6. How important to your choice of care is the ENT department at the Overton Brooks VA Medical Center as a whole?

0 1 2 3 4 5 6 7 8 9 10

7. How important to your choice of care is the ancillary staff (nurses) in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

8. How important to your choice of care is the timeliness/wait time in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

9. How important to your choice of care is the equipment/patient rooms in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

10. How important to your choice of care is the physician’s personality in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

11. How important to your choice of care is the physician’s clinical knowledge in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

12. How important to your choice of care are the physicians overall in the ENT department at the Overton Brooks VA Medical Center?

0 1 2 3 4 5 6 7 8 9 10

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor, and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 5 minutes. This includes the time it will take to follow instructions, gather the necessary facts, and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services, as well as customer expectations and desires. The results of this survey/evaluation will lead to improvements in the quality of service delivery by helping to shape the direction and focus of services and the patient experience. Participation in this survey is voluntary, and failure to respond will have no impact on benefits to which you may be entitled.

Comments concerning the accuracy of the survey burden estimate and suggestions for reducing this burden should be sent to:

Ameya Asarkar, MD - Staff Physician @ Ameya.asarkar@va.gov 318-990-4971