SURVEY-QUESTIONNIER

Dear Respondents
You are invited to participate in a study of Effective Governance in Primary Public Hospitals

to Quality Health Services. You were selected as a possible participant in this study as you are a

Patient’s of some Primary Public hospital in Malabon City which you knew the facilities, Doctor

Occupational well-being and Nursing Care of the said hospital. If you decided to participate, any

information that is obtained in connection with this study and that can be identified with you will remain

confidential and will not be disclosed. As a respondent, you will answer the given survey questionnaire

based from your experience and how you truly responds to the given set of rules.

Age: __________
Gender: Female Male

Instruction: Put a check for each statement on how you truly respond to the primary public hospital.
Read the descriptions first.

Scale: Level of Satisfaction

5-Highly Satisfied
4- Satisfied
3- Uncertain
2-Dissatisfied
1- Highly Dissatisfied
DESCRIPTION Highly Satisfied Uncertain Dissatisfied Highly
Satisfied (4) (3) (2) Dissatisfied
(5) (1)

1. Nurses’ regular checking of

your health status
2. Nurses’ willingness to know
about your needs & problems
3.The way nurses response for
your requests
4. The amount of time nurses
spent with you
5. Availability of nurses during
your needs
6. Quickness of nurses to
respond for your requests
7.Timely implementation of
routine care
8.Promptness of nurses
response to your call
9. Nurses’ efforts to make you
feel at home.
10. Nurses efforts to allay your
fear and anxiety
11. Reassurance and support
offered by nurses during your
periods of distress/ pain
12. Interest of nurses in
sharing your doubts & worries

13. Nurses’ pace and

smoothness in doing
procedures
14. Nurses’ skills in creation
of environment for promotion
of rest and sleep
15. Nurses’ skills in pain
management
16.Doctor listened to patients
problems attentively
17.Patients gives opportunity
to talk about his/her illness
18. Patients gives adequate
time during consultation
19. Patients gives information
regarding his/her health
condition
20.Doctor provided instruction
regarding dose and time of
medication
21.Doctor explained side
effects of medication
22. Doctor advised follow up
to the patient
23.Doctor took informed
consent before examination
24.Doctor made the patient
comfortable during the
examination
25.Doctor maintained privacy
during the examination
26. The doctors are very
competent and well-trained
27. The doctor treats me in a
very friendly and courteous
manner
28. Doctors act too business-
like and impersonal toward
me.
29. Doctors sometimes hurry
too much when they treat me.
30. Doubts about the ability of
the doctors who treat me.
31. Hospital room was kept
clean
32. Surrounding area was kept
quiet
33. Outpatient department was
clean
34. Bathrooms/latrines were
clean
35. Level of cleanliness
36. Attractiveness of the
waiting environment
37. Availability and conditions
of machines
38.Variety of foods offered
39. Availability and conditions
of Laboratory
40. Hours of operation
convenient for you
41. Signage and directions
easy to follow
42. Equipment and
infrastructure of the hospital
43.
44.
45.

DESCRIPTION Highly Satisfied Uncertain Dissatisfied Highly

Satisfied (4) (3) (2) Dissatisfied
(5) (1)

1. I think my doctor's office has

everything needed to provide
complete medical care
2. The medical care I have been
receiving is just about perfect
3. Doctors are good about
explaining the reason for
medical tests
4. Doctors do not make me
wonder if their diagnosis is
correct
5. I feel confident that I can get
the medical care I need without
being set back financially
6. When I go for medical care,
they are careful to check
everything when treating and
examining me
7. I do not have to pay more
than I can afford for my
medical care
8. I have easy access to the
medical specialists I need
9. Where I get medical care,
people do not have to wait too
long for emergency treatment
10. Doctors are not too business
like and impersonal toward me
11. My doctors treat me in a
very friendly and courteous
manner
12. Those who provide my
medical care are not too much
in a hurry when they treat me
13. Doctors do not ignore what
I tell them
14. I trust the ability of the
doctors who treat me
15. Doctors usually spend
plenty of time with me
16. It's easy to get an
appointment for medical care
right away
17. I am satisfied with the
medical care I receive
18. I am able to get medical
care whenever I need it
19. I do get the medical care
even with some delay.
20. Doctor is being friendly that
I don’t feel shy toward him/her.