Guide for 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: __ __ -__ __ -__ __
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.
2. I feel the council will be effective in improving communication between patients and health care providers.
3. I feel the council identified problems and barriers to safe medication management.
4. I feel my participation on the council will improve my own safe medication management or the safe medication management of my patients.
5. I feel the ideas generated today will develop into interventions to successfully improve medication safety.
6. The facilitator(s) honored everyone's contribution and ensured we stayed on focus.
7. The meeting's desired outcomes were achieved.
8. I felt my time today was well spent.
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.
Page originally created December 2012