Event Feedback Form (HA staff and Physicians)

Company

This field is for validation purposes and should be left unchanged.

Meeting Name(Required)

Meeting Date(Required)

Name of the participant (optional)

Please select the group that represents you the best(Required)

1) Please indicate what objectives of the Facility Engagement Initiative’s Memorandum of Understanding were met, if any (check all that apply):(Required)

To improve communication and relationships among the medical staff so that their views are more effectively represented.

To prioritize issues that significantly affect physicians and patient care.

To support medical staff contributions to the development and achievement of health authority plans and initiatives that directly affect physicians.

To have meaningful interactions between the medical staff and health authority leaders, including physicians in formal HA medical leadership roles.

2) Please rate the extent to which you agree with the following(Required)

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
a) Overall I am satisfied with this event/meeting
b) This event/meeting was a good use of my time
c) I would attend a similar event/meeting in the future
d) This event/meeting allowed me to engage with my colleagues
e) This event/meeting met its overall objective(s)
f ) I am satisfied with the virtual meeting format, food, and overall organization of this event

3) Please identify the type of engagement that was achieved during this event/meeting (pick only one!):(Required)

I was informed by being provided with information on an activity, project or policy

I was consulted to obtain feedback on key decisions or activities, and informed (or will be informed) of how my feedback will be used

I collaborated with decision makers to provide my advice, leadership and recommendations on a project, activity or policy

I was empowered to be a joint partner in decision-making on a project, activity or policy.

4) Did this event/meeting include the right mix of participants and stakeholders? Are there additional participants and stakeholders you would have like to see included in a future similar event?(Required)

5) How could this event/meeting be improved?(Required)

6) Other Comments(Required)