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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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샘플 질문

템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.

질문 12개 · 약 7분
Q01
메시지

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
객관식필수

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
의견 척도필수

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

척도: 1 – 5
최소:Never최대:Constantly
Q04
매트릭스필수

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

4개 행 × 5개 열
  • 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.
열: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q05
객관식

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
평점 척도

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

범위: 1 – 5
최소:Poor최대:Excellent
Q07
최선·최악 선택형(MaxDiff)필수

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
세트별 최선·최악 선택최선:Holds me back the most최악:Holds me back the least
Q08
의견 척도필수

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

척도: 0 – 10
최소:Never최대:Constantly
Q09
AI 인터뷰

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
객관식

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
객관식

How long have you worked here?

  • Less than 1 year
  • 1-3 years
  • 3-7 years
  • 7+ years
  • Prefer not to say
Q12
메시지

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.

포함된 기능

  • AI 후속 질문

    정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.

  • 주의력 확인 장치

    성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.

  • AI가 작성한 문안

    문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.

  • 자동 리포트

    응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.

다른 서비스와 비교

다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.

이 템플릿을 선택하는 이유

  • 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.

잘하는 점

  • 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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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.

잘하는 점

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

아쉬운 점

  • 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

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