Page 1 of 1

Appendix F. Meeting Evaluation

Developing a Community-Based Patient Safety Advisory Council

Appendix F. Meeting Evaluation


Each 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 Evaluation

Date: __ __ -__ __ -__ __

Scale: 1 = Strongly Disagree     3 = Agree     5 = Strongly Agree

Your 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 Agree

2. 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 Agree

3. I feel the council identified problems and barriers to safe medication management.

1                    2                     3                     4                    5
Strongly Disagree                 Agree                     Strongly Agree

4. 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 Agree

5. I feel the ideas generated today will develop into interventions to successfully improve medication safety.

1                    2                     3                     4                    5
Strongly Disagree                 Agree                     Strongly Agree

6. The facilitator(s) honored everyone's contribution and ensured we stayed on focus.

1                    2                     3                     4                    5
Strongly Disagree                 Agree                     Strongly Agree

7. The meeting's desired outcomes were achieved.

1                    2                     3                     4                    5
Strongly Disagree                 Agree                     Strongly Agree

8. I felt my time today was well spent.

1                    2                     3                     4                    5
Strongly Disagree                 Agree                     Strongly Agree

If 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