Form 0917-0036 Employee Assessment- Clinton Service Unit - IMPRESS

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

OMB No. 0917-0036-10 IMPRESS Employee Assessment - 2015.pub

Employee Assessment- Clinton Service Unit - IMPRESS

OMB: 0917-0036

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Phone: 580-323-2884

Fax: 580-323-2579

10321 N 2274 Rd.

Rt1, Box 3060

Clinton, OK 73601

Indian Health Service

Clinton Service Unit

Clinton/El Reno/Watonga

IHS Directors

Service Excellence Priorities

To renew and strengthen our partnership with tribes

To reform the IHS

To improve the quality of and access to care 

To make all our work accountable, transparent, fair, and inclusive

Background

The staff at Clinton Service Unit is taking on the challenge of obtaining……..

Customer Service Excellence.

Five Star Customer Service starts with YOU!

This survey will help us as a Service Unit to improve customer service and patient care utilizing these five elements:

Performing– Looking at ways to learn about and improve on the services we provide.

Rounding– Improving communication with patients by building relationships and learning what our patients want and need.

Expecting– Establishing goals and meeting expectations of our patients.

Scripting– Making sure that we are sending the same message to our patients and delivering consistent information.

Storytelling– Stories are very valuable and can be used to communicate information, build up a community or initiate action. We hope that you will share a story with us about your experience here as an employee of the Clinton Service Unit. .

Continually Improving Patient Care

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0917-0036.

The time required to complete this information collection is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.

Form Approved

OMB Form No. 0917-0036

Expiration Date:

PERFORMING

My Supervisor regularly communicates expectations of my job performance.

Strongly Agree Agree Neutral Disagree Strongly Disagree

I am provided with opportunities for professional development.

Strongly Agree Agree Neutral Disagree Strongly Disagree

My supervisor provides updated department/Service Unit Information.

Strongly Agree Agree Neutral Disagree Strongly Disagree

Other departments deliver service needed to perform my job.

Strongly Agree Agree Neutral Disagree Strongly Disagree

ROUNDING

I am able to talk to my supervisor regarding issues or concerns.

Strongly Agree Agree Neutral Disagree Strongly Disagree

My ideas/suggestions are taken seriously by my supervisor.

Strongly Agree Agree Neutral Disagree Strongly Disagree

I have the full attention of my supervisor when I am speaking.

Strongly Agree Agree Neutral Disagree Strongly Disagree

EXPECTING

The patients of the Clinton Service Unit receive quality health care from the staff.

Strongly Agree Agree Neutral Disagree Strongly Disagree

My supervisor holds the same expectations of job performance for themselves as they expect from their employees.

Strongly Agree Agree Neutral Disagree Strongly Disagree

Staff are held accountable for the quality of work they produce.

Strongly Agree Agree Neutral Disagree Strongly Disagree

The amount of work in this organization allows me to do my best.

Strongly Agree Agree Neutral Disagree Strongly Disagree

SCRIPTING

There is a feeling of teamwork and cooperation in the Clinton Service Unit.

Strongly Agree Agree Neutral Disagree Strongly Disagree

If I make a mistake, I am encouraged to learn from it.

Strongly Agree Agree Neutral Disagree Strongly Disagree

I understand how my work contributes to the overall success of the organization.

Strongly Agree Agree Neutral Disagree Strongly Disagree

My supervisor greets me when I see him or her.

Strongly Agree Agree Neutral Disagree Strongly Disagree

I know how to greet customers or clients on the phone or in person.

Strongly Agree Agree Neutral Disagree Strongly Disagree

STORYTELLING

Do you have a good story for internal customer service?

Do you have a bad story for internal customer service?

What do you feel you can do or what have you seen done to improve customer service?

Please return your completed survey to any one of the white comment card boxes throughout the facility.

Thank you for taking the time to complete this survey.

May we contact you to further discuss your comments or your story?

Employee Name: Contact number:

File Typeapplication/vnd.ms-office
AuthorHenry, Robina (IHS/OKC)
File Modified0000-00-00
File Created0000-00-00

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