Appendix F. Meeting Evaluation Developing a Community-Based Patient Safety Advisory Council Appendix F. Meeting EvaluationEach council member should be asked to complete an evaluation after each meeting, and meeting leaders should share the results of these evaluations at every meeting. A sample evaluation form follows.Council Meeting EvaluationDate: __ __ -__ __ -__ __Scale: 1 = Strongly Disagree 3 = Agree 5 = Strongly AgreeYour input about what worked for you and what didn't is truly important to us. Please give us your feedback.1. I was comfortable expressing my ideas and opinions.1 2 3 4 5 Strongly Disagree Agree Strongly Agree2. I feel the council will be effective in improving communication between patients and health care providers.1 2 3 4 5 Strongly Disagree Agree Strongly Agree3. I feel the council identified problems and barriers to safe medication management.1 2 3 4 5 Strongly Disagree Agree Strongly Agree4. I feel my participation on the council will improve my own safe medication management or the safe medication management of my patients.1 2 3 4 5 Strongly Disagree Agree Strongly Agree5. I feel the ideas generated today will develop into interventions to successfully improve medication safety.1 2 3 4 5 Strongly Disagree Agree Strongly Agree6. The facilitator(s) honored everyone's contribution and ensured we stayed on focus.1 2 3 4 5 Strongly Disagree Agree Strongly Agree7. The meeting's desired outcomes were achieved.1 2 3 4 5 Strongly Disagree Agree Strongly Agree8. I felt my time today was well spent.1 2 3 4 5 Strongly Disagree Agree Strongly AgreeIf Disagree, why? _____________________________________________________________________________________________ _____________________________________________________________________________________________9. The following individual(s) or community group(s) should be part of the council: _____________________________________________________________________________________________ _____________________________________________________________________________________________10. To improve future meetings, we should do the following: _____________________________________________________________________________________________ _____________________________________________________________________________________________My thoughts or comments: _____________________________________________________________________________________________ _____________________________________________________________________________________________If you would like to be contacted about any of your thoughts or comments, please note your name.________________________________________________________Return to Contents Proceed to Next Section Current as of April 2008 Internet Citation: Appendix F. Meeting Evaluation: Developing a Community-Based Patient Safety Advisory Council. April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/patient-safety-advisory-council/appendix-f.html
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