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  • 8/8/2019 Patient Assessment Survey

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    Patient Assessment of Cultural Competency Questionnaire*

    The purpose of the attached ten question survey is to assess patient satisfaction with their experiences withstaff in a given department or clinic. It allows the patients to assess the cultural appropriateness and sensitivityof the environment, materials, and staff in that setting. We suggest that it be used before the staff undergoescultural competence training, and again one to six months later to assess the effect of the training.

    Survey responses can be entered into an Excel sheet or other database for purposes of trackingchanges in responses after participating in trainings. Please note that your institution may requireapproval by a human subjects committee or similar entity before distributing the surveys.

    *Data for this survey can be entered on the excel sheet entitled Patient Assessment SurveySpreadsheet, which is available on the LEAD Program website under resources, tools:http://futurehealth.ucsf.edu/TheNetwork

    Developed by Leah Karliner, M.D.Supported by funding from The California Endowment

    Copyright 2006 UCSF Center for the Health Professionshttp://futurehealth.ucsf.edu/TheNetwork/

    http://futurehealth.ucsf.edu/TheNetworkhttp://futurehealth.ucsf.edu/TheNetwork/http://futurehealth.ucsf.edu/TheNetworkhttp://futurehealth.ucsf.edu/TheNetwork/

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