Proactive Care Physician Feedback Tool
Name: ______Date: ______Area:______Department:______Medical Office Building ______
NUID:______
In Basket SupportKey: 0 = Extremely Dissatisfied 3 = Dissatisfied 5 = Neutral 8 = Satisfied 10 = Extremely Satisfied / Rating 0-10 / I prefer to do this myself / Not an expectation in my department
1 / Clinical staff members assist with the screening and staging of patient telephone messages
2 / Telephone messages are effectively screened so that I do not receive messages that could have been managed to completion by clinical staff members
3 / Telephone messages that are routed to me are effectively staged so that I can manage them in one touch
4 / Clinical staff members assist with the screening and staging of patient eMail messages
5 / eMail messages are appropriately screened so that I do not receive messages that could have been managed to completion by clinical staff members
6 / eMail messages that are routed to me are effectively staged so that I can manage them in one touch
7 / When managing telephone and eMail messages clinical staff members accurately and consistently stage orders for DME
8 / Clinical staff members consistently and effectively perform all the tasks expected by myself and our department for telephone and eMail message management.
9 / My department administrative team (DA, ADA, Supervisors) works to improve message and in-basket support I receive
10 / My department Chief/PIC works with the administrative team to improve the message and in-basket support I receive
11 / I am satisfied with the message management and in basket support I receive
Comments:
Key: 0 = Extremely Dissatisfied 3 = Dissatisfied 5 = Neutral 8 = Satisfied 10 = Extremely Satisfied
Key: 0 = Extremely Dissatisfied 3 = Dissatisfied 5 = Neutral 8 = Satisfied 10 = Extremely Satisfied / Rating 0-10 / I prefer to do this myself / Not an expectation in my department
1 / I have a clinical staff member* who is consistently assigned to work with me when I am in clinic.
2 / My regularly assigned clinical staff member consistently and effectively performs all the tasks expected by myself and our department for medical office visits.
3 / The float and on-call clinical staff consistently performs my department’s standard work flows for medical office visits.
4 / The work I delegate to the clinical staff members is completed in a timely and appropriate manner.
5 / During office visits the clinical staff members properly stage orders ( e.g., care gaps, point of care tests and immunizations ) with diagnosis and order associations.
6 / During office visits the clinical staff members accurately stage orders for DME.
7 / Clinical staff members are well trained and proficiently perform all clinical and HealthConnect tasks.
8 / Patient forms are thoroughly prepped by office staff before presenting to physicians for review and completion.
9 / My department administrative team (DA, ADA, Supervisors) works to improve the medical office support I receive.
10 / My department Chief/PIC works with the administrative team to improve the module support I receive.
11 / I am satisfied with the support I receive in the module/office visit setting.
Comments:
Key: 0 = Extremely Dissatisfied 3 = Dissatisfied 5 = Neutral 8 = Satisfied 10 = Extremely Satisfied