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Employee & HR

Employee Concern for Patient Care and Safety Survey

Measures how attuned staff feel to patients' needs and how safe they feel speaking up about care or safety concerns, surfacing barriers to raising issues and signs of moral distress. Built for healthcare and care-setting HR and quality teams, with an AI follow-up that reconstructs what actually happened the last time an employee flagged a concern.

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設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全12問・約7分
Q01
メッセージ

Thanks for taking a few minutes for this. We want to understand how comfortable you feel noticing and acting on concerns about patient care and safety — there are no right answers, just your honest experience. Your responses are completely confidential and anonymized. About 5 minutes.

Q02
選択式必須

How much direct contact do you have with patients in a typical week?

  • None
  • Occasional (a few times a week)
  • Frequent (daily)
  • Constant (most of my shift)
Q03
オピニオンスケール必須

In the last 30 days, how often did you notice something that made you concerned about a patient's care, safety, or comfort?

スケール: 1 – 5
最小:Never最大:Constantly
Q04
マトリクス必須

How much do you agree with each statement about your workplace?

4行 × 5列
  • I feel comfortable speaking up when I notice something that could affect a patient's care or safety.
  • My supervisor takes it seriously when I raise a concern about a patient.
  • I trust that raising a concern about patient care won't affect how I'm treated at work.
  • My team responds quickly when a patient's needs change.
列: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
選択式

The last time you noticed a concern about a patient, what did you do?

  • Reported it to a supervisor or charge nurse
  • Documented it in the patient's chart
  • Raised it directly with the care team
  • Escalated it to a manager or safety officer
  • Didn't do anything
Q06
評価スケール

How would you rate the organization's response the last time you raised a concern about a patient?

範囲: 1 – 5
最小:Poor最大:Excellent
Q07
ベスト・ワースト選択（MaxDiff）必須

Which of these most and least holds you back from raising a concern about a patient's care?

  • Fear of being blamed
  • Not sure who to tell
  • Too busy, no time
  • Belief that nothing will change
  • A past negative experience raising concerns
  • Unclear reporting process
  • Worry about my relationship with coworkers
各セットで最も良いもの・最も悪いものを選択最も良い:Holds me back the most最も悪い:Holds me back the least
Q08
オピニオンスケール必須

How often do you feel unable to do what you believe is right for a patient because of time, staffing, or policy constraints?

スケール: 0 – 10
最小:Never最大:Constantly
Q09
AIインタビュー

Reconstruct the most recent time the respondent noticed a concern about a patient's care or safety: what specifically they noticed, who (if anyone) they told, what happened after, and whether it was resolved to their satisfaction. If they said they didn't do anything, probe what stopped them and what would have made it easier to speak up. Anchor on their rating scale answers about comfort speaking up and organizational response to understand the gap between how safe they feel raising concerns and what actually happens when they do.

Q10
選択式

Which best describes your role?

  • Nursing or clinical staff
  • Physician or provider
  • Allied health professional
  • Administrative or support staff
  • Other
  • Prefer not to say
Q11
選択式

How long have you worked here?

  • Less than 1 year
  • 1-3 years
  • 3-7 years
  • 7+ years
  • Prefer not to say
Q12
メッセージ

Thank you for your honesty. These responses go directly to leadership to identify where staff need more support to raise and resolve concerns about patient care.

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Includes an AI follow-up interview that reconstructs exactly what happened the last time an employee flagged a patient concern, rather than stopping at a static rating
  • Combines quantitative measures (opinion scale on frequency of concerns, matrix on workplace agreement, rating of the organization's response, max-diff on barriers) with open reconstruction of a real incident
  • Directly probes moral distress with a dedicated opinion-scale item ('unable to do what you believe is right for a patient because...'), which generic workplace-safety forms don't ask
  • Segments by patient contact level, role, and tenure so healthcare/quality teams can see which staff groups feel least safe speaking up

QuestionPro

Employee Concern for Patients Survey Template

This is a directly comparable, fielding-ready template on the exact topic of employee concern for patients. It's a static questionnaire without any adaptive follow-up, so every respondent answers the same fixed set of questions regardless of what they report.

優れている点

  • Purpose-built for the same patient-concern topic
  • Backed by an established survey platform with broad question-type support
  • Ready to deploy without custom build-out

物足りない点

  • No adaptive AI follow-up to reconstruct what actually happened in a flagged incident
  • No automated per-response quality scoring
  • No published prompt-level methodology for how questions probe deeper

SurveySparrow

Free Workplace Safety Templates That Actually Work

This reads as a general workplace-safety template collection/guide rather than a template specifically built around patient care or moral distress. It's useful for general safety-concern intake but not tailored to healthcare/care-setting dynamics.

優れている点

  • Conversational form format that may feel less clinical than a traditional survey
  • Free to use
  • Covers general workplace safety concerns broadly

物足りない点

  • Not specific to patient care or clinical moral distress
  • Static form with no adaptive probing of what happened in a specific incident
  • No transparent, published methodology behind question flow

Jotform

Workplace Safety and Concerns Form Template

A general-purpose workplace safety and concerns intake form, not tailored to patient care settings or moral distress specifically. It's a fielding-ready static form, good for basic incident logging but not for nuanced attitudinal measurement.

優れている点

  • Simple, ready-to-use form builder template
  • Familiar Jotform ecosystem for embedding and routing submissions
  • Flexible for general safety-concern reporting

物足りない点

  • No patient-care-specific framing or moral distress measurement
  • No adaptive AI interview to reconstruct incidents
  • No automated quality scoring of open responses

Typeform

Employee Safety Survey Template

A general employee safety survey template, not specific to patient care or healthcare settings. Typeform's conversational UI is polished, but the template itself is a fixed question set without adaptive follow-up.

優れている点

  • Polished, conversational one-question-at-a-time interface
  • Easy to customize branding and question wording
  • Established platform with wide integration support

物足りない点

  • No healthcare/patient-care-specific content or moral distress items
  • Static question flow with no AI-driven follow-up on flagged incidents
  • No automated per-response quality scoring or transparent prompt methodology

よくあるご質問

「Employee Concern for Patient Care and Safety Survey」テンプレートにはどのような設問が含まれていますか？

すぐに使える設問が12問含まれており、最初の設問は次のとおりです：「Thanks for taking a few minutes for this. We want to understand how comfortable you feel noticing and acting on concerns…」・「How much direct contact do you have with patients in a typical week?」・「In the last 30 days, how often did you notice something that made you concerned about a patient's care, safety, or comfo…」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか？

回答者は通常、12問を約7分で回答し終えます。

テンプレートは編集できますか？

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか？

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか？

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

このテンプレートを使う無料で始める

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