Measuring Customer Satisfaction
Nine Steps to Success





|

www.astho.org



 1
Table of Contents







 





8




 







2
Measuring Customer Satisfaction
Introducon



[H]ealth departments must document how customer/stakeholder feedback was collected,
analyzed, and conclusions drawn from two different types of customers (e.g., vital statistics
customers; food establishment operators; individuals receiving immunizations, screenings or
other services; partners and contractors; elected officials, etc.) [Standard 9.1.4A]




why




How to Use This Guide





Standards and Measures Version 1.5



Survey Planning and Administrave Checklist

Task Checklist










  3
Planning and Administraon
Step 1: Idenfy the Purpose of the Survey



Purpose Surveys












































4
Monitoring Programs at an Overview Level





Step 2: Select a Program (or Set of Programs) and Idenfy “Customers” to Be Surveyed













 training 







Step 3: Determine How Results Will Be Used












 .
  5


Step 4: Determine Your Budget and Plan Within It








SurveyMonkey








not

Step 5: Idenfy People to Include in Survey Planning and Implementaon



valid
and reliable,








ValidReliable



6
Step 6: Design the Survey


Surveys should be as short as possible. The length of



Write clear quesons and response opons in the
appropriate literacy level and language
Limit each queson to one idea or concept, avoiding
double-barreled quesons

Use convenonal language
Make quesons easy to answer
Survey customers soon aer they have received services or interacted with your sta, when memories
are fresh

Keep survey quesons standard if you want to compare results over me

Target quesons on the factors that most inuence customer sasfacon for a parcular service or
product.




















  7

 


 gained

Value of Anonymity:  



Selecng Survey Scales: 




How sased were you with the quality of materials?









The inspector took me to clarify informaon.

















Tracking and Following Up on Complaints: 



 has shown that


8



Tracking and Comparing Responses from Subsets of Clients: 






Appendices B and D





Cover Leer, Introducon, and Acknowledgement:






Movang Clients to Respond: 






Step 7: Select Survey Administraon Methods
2
Customer Surveying: A Guidebook for Service Managers





Mail Surveys: 





Customer Surveying: A Guidebook for Service Managers

  9
Comparison of Survey Administrave Methods







    
 Slow   
    
   None 


None None  
    
Electronic Mail or Web-Based Surveys:








Telephone Surveys: 





In-Oce Surveys Using Drop Boxes or Kiosks: 









Selecng Survey Samples:





10
Frequency of Survey Administraon: 








Response Rates: 















https://bphc.hrsa.gov/datareporting/research/hcpsurvey/
dashboardmanual/datafilevariables.html
Step 8: Pilot the Survey and Modify Before Full-Scale Rollout





Step 9: Analyze the Data, Report, and Follow Up







Improving Response
Rates
The 
developed a customer satisfaction
survey distribution process 






  11
Applying Your Findings


















Conclusion








12
APPENDIX A
References


American Medical News







 














Customer Surveying: A Guidebook for Service Managers




http://qiroadmap.org/?wpfb_dl=46
  13
APPENDIX B
Mul-Purpose Surveys
1. Michigan’s Customer Survey Template developed by Michigan Public Health Instute (MPHI) in
partnership with the Michigan Department of Community Health (MDCH) that can be modied
for use by Local Health Departments.
Local Health Department Name

Local Health Department Name.








Instrucons for Compleng the Survey



Local Health Department Name
 Local Health Department Name









14







 




 





 

Yes No



  15

 


Strongly
Disagree
Disagree
Somewhat
Disagree
Somewhat
Agree
Agree
Strongly
Agree




















Local Health Department Name
Local Health
Department Name

 


No
 
16
 
 


 


 




 








  17
 






 






 





18
2. Florida’s Customer Sasfacon Survey




























 





Addional Comments:
May we contact you?

  19
APPENDIX C
Program-Specic Surveys
1. New Jersey (Morris Regional Partnership), Retail Food Owner/Operator Sasfacon Survey
 
  Neutral  

 
  Not enough

 
  Neutral  

 

  Neutral  

20
 
  Neutral  

 
  Neutral  

 
  Neutral  

 
  Neutral  

 
    

  21
 
  Neutral  

 
  Neutral  

 
  No

Please mail completed survey to:



22
2. Washington County, MN: Sepc Survey (SurveyMonkey Format)
Survey - Septic
Cust Satisfaction Survey – Septic
Page 1
Customer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - Septic
The Washington County Department of Public Health and Environment is continually working to improve our services.
P
lease complete this brief
eight
question survey.
Your feedback is important
and will help us improve future inspections.
A
ll responses are anonymous unless you choose to provide your contact
information at
the end of
the survey.
Thank you
for your input!
1. Have you had a septic inspection within the last 12 months?
2. Please rate the following statements regarding your inspector.
3. Please rate the following statements regarding information and services.
Customer Satisfaction Survey
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
The inspector was
knowledgeable
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
The inspector was patient
a
nd
took
time
to
clarify
information
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
The inspector was polite
and friendly
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
The inspector was helpful
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Not Applicable
Services were provided at a
convenient time
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
Applications, forms, and
ot
her materials were clear
and
easy to understand
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
I received the information
and resources I needed
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
I understand the code
requirement
s that
were
ident
ified by the inspector
nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj
Yes
nmlkj
No
nmlkj
  23
Page 2
Customer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - Septic
4. Overall, how satisfied were you with the inspection process?
5. Please share one thing we could do to improve our inspection process.
6. What is your preferred method of receiving communication from our department?
7. Additional comments or suggestions:
5
5
6
6
5
5
6
6
Very Satisfied
nmlkj
Satisfied
nmlkj
Neutral
nmlkj
Unsatisfied
nmlkj
Very Unsatisfied
nmlkj
Mail
gfedc
Email
gfedc
Phone
gfedc
Text Message
gfedc
Website
gfedc
Facebook
gfedc
Twitter
gfedc
Blog
gfedc
24
Page 3
Customer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - SepticCustomer Satisfaction Survey - Septic
9. Please enter your contact information below.
Thank you for participating in the survey. We appreciate your input. Feel free to contact your inspector if you have
quest
ions at
651
-
430
-
6655.
Name:
Company:
Address:
Address 2:
City/Town:
State:
6
ZIP:
Email Address:
Phone Number:
Yes
nmlkj
No
nmlkj
  25
3. Washington County, MN: Hazardous Waste (Mail Format)
Hazardous Waste Program Sasfacon Survey







1. Have you had a hazardous waste inspecon in the last 12 months?
 No
2. Please rate these statements regarding the inspector or person who worked with you on the
inspecon.

  Neutral   

  Neutral   

  Neutral   

  Neutral   
26
3. Rate the following statements regarding informaon and services.

  Neutral   

  Neutral   

  Neutral   

  Neutral   
4. Overall, how sased were you with the inspecon process?
  Neutral   
5. Please share one thing we could do to improve our inspecon process.





nd


  27
APPENDIX D
Stakeholder Surveys and Other Means for Input
1. New Yorks Process for Obtaining Stakeholder Input
The Process for Obtaining Input from Stakeholders
The Ad Hoc Committee to Lead New York’s State Health Improvement Plan, under the direction of the
Public Health and Health Planning Council’s Committee for Public Health, coordinated the process used
to obtain input from stakeholders. Committee members conducted sessions with stakeholders to obtain
feedback on the 2008-2012 Prevention Agenda and how the process could be improved for the 2013-
2017 Prevention Agenda. Input was sought on the proposed priorities for the next planning cycle and
how best to ensure continuing involvement of stakeholders in designing and implementing
interventions.
A Vision and Proposed Priorities slide set was developed for committee members to use during these
sessions. In addition, slide sets describing the priorities for the previous Prevention Agenda, including
progress to date, were posted on the NYSDOH website so they could be accessed by stakeholders.
Members organized meetings with stakeholders and used the slide sets and a process to obtain answers
to the questions shown in Figure 1. Answers could also be submitted via the website. If committee
members preferred to give stakeholder the option to complete the survey, they were asked to review
key points and encourage a discussion beforehand.
The members coordinating these meetings knew that they needed to clearly understand the questions
and reasons for asking them. Their role was to facilitate a discussion on what worked in the previous
Prevention Agenda, the challenges, the strategies used to address the challenges, and how lessons
learned can be used to shape new priorities. Progress reports on all the existing priorities were used to
facilitate these discussions.
Figure 1. Questions for Stakeholders
1. What did communities view as strengths in their experiences working with the 2008-2012
Prevention Agenda?
2. What were some challenges working with the 2008-2012 Prevention Agenda?
3. How can these strengths and challenges be addressed through the next version in the
2013-2017 Prevention Agenda?
4. What are key issues that need to be addressed in the 2013-2017 Prevention Agenda?
28
Five additional questions were given to the coordinators to be considered in these sessions:
1. What went well or not so well with the 2008-2012 Prevention Agenda from the perspective of
your organizations? For any specific priority area that your organization may have participated
in, what went well or not so well?
2. How do we achieve greater participation from stakeholder organizations (including yours) in the
local community health planning and implementation process?
3. How can we assure that our new plan addresses disparities in each of the priority areas?
4. Does the proposed set of five priority areas for 2013-2017 Prevention Agenda address the
priorities or concerns in your community or for your organizations?
If so, how might your community organization be most effective in addressing one or more of
the priorities?
If not, how would you change them or what different priorities would you suggest?
5. Would a member of your organization be willing to serve on a committee to address an
identified issue?
The information obtained from these sessions was used to help the Ad Hoc Committee finalize priorities
and to inform Phase 2 of the planning process, in which workgroups identified measures, strategies,
interventions and partner organizations for each priority.
Findings
Recommendations were obtained from 50 groups, varying in size from 5 to 25 people. More than 750
individuals provided feedback in this process. The feedback was organized into three theme areas:
Inputs related to infrastructure (communication and coordination, partners and sectors, data
and measures, financial and policy supports, and workforce).
Outputs related to specific priorities and strategies to consider for each priority. Comments on
the new priorities are summarized in a separate report.
Cross-cutting issues, such as disparities, social determinants of health, the overall framework
(vision, goals, principles, etc.), and any gaps or concerns.
What did communities view as strengths in their experiences working with the 2008-2012
Prevention Agenda?
Overall, the encouragement by NYSDOH for hospitals and local health departments to
collaborate on community needs assessments and planning did result in the desired
collaboration in most counties.
Identifying the 10 priorities in the 2008-2012 Prevention Agenda allowed groups to focus on
common themes.
Having specific priorities enabled groups to leverage resources.
Collaboration and action were easier if the partners understood and believed in the benefits
of addressing the priorities, and had access to content experts.
It was easy to work on broad priority areas, such as access to care.
Communication about the 2008-2012 Prevention Agenda was much more intense in the
beginning and, overall, seemed adequate.
  29
What were some challenges working with the 2008-2012 Prevention Agenda?
Some organizations found it harder to collaborate than others, possibly because they were
smaller, had fewer resources, were on the geographic fringes of their more powerful
partners, or the partners were not clear about their roles. Sometimes, hospitals and local
health departments did not collaborate, but when asked whether it was important to do so,
they said it was.
Not having access to content experts made it difficult to work on some issues.
Lack of funding was a challenge for some, although few elaborated on specific funding
needs.
Priority issues such as access to care and mental health were too broad. It was difficult to
identify actions that could be taken at the local level to have an impact on the priority.
There was a lack of access to data at the ZIP code level to identify disparities.
Some groups did not see any challenges with respect to the 2008-2012 Prevention Agenda.
How can these strengths and challenges be addressed through the next version, the 2013-2017
Prevention Agenda?
Ensure that priorities and implementation of activities are connected with the “voice of the
customer.” Include “voice of community” at every stage and every level.
Collaborate within and across sectors, while continuing to encourage collaboration between
the various partners especially local health departments and hospitals.
Focus on reducing disparities and addressing social determinants of health.
Present data at the sub-county level.
Include long-term indicators and intermediate measures.
What should the specific priorities be in the State Health Improvement Plan, and what should the
2013-2017 Prevention Agenda include?
Prevent chronic diseases.
Promote a healthy and safe environment.
Promote healthy women, infants and children.
Promote mental health and prevent substance abuse.
Prevent HIV, STDs, vaccine-preventable diseases and health care-associated infections.
A detailed summary of the responses to these questions from stakeholder groups is posted on the
Department of Health website at:
http://www.health.ny.gov/prevention/prevention_agenda/2013-2017/establishing_priorities.htm.
30
2. Michigan’s Online Early Hearing Detecon and Intervenon Program Sasfacon Survey


1
TheMich
i
program
s
efficiency
,
SurveyIn
t
TheEarly
receiving
orderto
b
appreciat
response
s
identifiab
declinet
o
Wewoul
d
Ifyouha
v
[InsertN
a
[InsertE
m
[InsertTe
Thankyo
u
Survey
DateSur
v
Demogra
p
1.
W
2. I
n
_
_
Michigan
D
EHDICusto
m
Michiga
n
i
ganDepart
m
s
thatareres
p
,
andservice
t
roduction
HearingDet
e
feedbackon
b
etterserve
y
eyourtime
a
s
willbefully
lebyyouran
o
answerany
d
appreciate
y
v
eanyquesti
o
a
me]
m
ailAddress]
lephoneNu
m
u
!
v
eyComplete
p
hicInforma
t
W
hatisyour
p
BirthHosp
Audiologis
t
Physician/
E
Physician/
P
Physician/
F
EarlyOnC
o
LocalHeal
t
OtherProf
n
whatcount
y
_
_________
_
D
epartmento
f
m
erSatisfac
t
n
Departme
n
EarlyHeari
n
m
entofCom
m
p
onsivetocu
s
quality,wee
n
e
ctionandIn
t
theprogram
y
ou.Weenc
o
a
ndfeedback
confidential,
swers.Your
p
question.
y
ourrespons
o
nsaboutthi
m
ber]
d:________
_
t
ion
p
rofessional
a
i
talStaff
t
E
NT
P
ediatrician
F
amilyPracti
c
o
ordinator
t
hDepartme
n
e
ssional(ple
a
y
orcounties
_
__________
_
f
Community
t
ionSurvey2
0
n
tofCommu
n
n
gDetection
Customer
m
unityHealth
s
tomerneed
s
n
courageyo
u
t
ervention(E
fromprofes
s
urageyouto
.Thesurvey
w
resultswill
o
p
articipation
e
by[enterd
a
ssurvey,ple
a
_
_________
_
a
ffiliationwit
h
c
e
n
t
a
sespecify):
_
doyouprovi
_
_________
_
Health
0
12
n
ityHealth
andInterve
n
Satisfaction
S
(MDCH)stri
v
s
.Tomaintai
n
u
toshareyo
u
HDI)progra
m
s
ionals,soim
taketimeto
w
illtakeapp
r
o
nlyberepor
t
inthissurve
y
a
tebywhich
a
secontact:
_
_____(MM/
h
EHDI?(Plea
_
__________
_
deservices?
_
___
PublicHealt
n
tion(EHDI)
P
S
urvey
v
estoprovid
e
n
orimprove
c
u
rthoughts,
i
m
isintereste
d
provements
c
completeth
i
r
oximately1
0
t
edinaggreg
y
iscomplete
l
youwouldli
k
/
DD/YYYY)
secheckallt
_
_________
_
t
hAdministr
a
P
rogram
e
highqualit
y
customersa
t
i
deas,andfe
e
d
inassessin
g
c
anbeidenti
issurveyand
0
15minutes
ate,andyou
lyvoluntary
a
k
etoreceive
t
hatapply)
_
_____
a
tion
y
servicesan
d
t
isfaction,
e
dback.
g
knowledge
a
fiedandma
d
sincerely
tocomplete
.
willnotbe
a
ndyouaref
r
responses].
d
a
nd
d
ein
.
Your
r
eeto
  31
2
Knowled
g
3. P
n
I
a
n
I
u
n
N
i
s
I
a
g
o
I
u
4.
W
5.
W
6.
W
s
t
7.
W
a
r
8.
W
a
r
9.
W
a
r
Michigan
D
EHDICusto
m
g
eofStateLa
leaseindicat
e
e
wbornscre
e
a
mawareof
e
wbornscre
e
u
nderstandt
e
wbornscre
e
ewbornhea
r
s
mandatoryi
a
mawareof
o
als.
u
nderstandt
W
hatchallen
g
W
hatdoyou
f
W
henaninfa
n
t
ateEHDIpr
o
VeryEffec
t
Effective
Somewhat
Somewhat
NotEffecti
NotAtAll
E
W
hatsuggesti
r
eneededaf
t
W
hatsuggesti
r
eneededaf
t
W
hatsuggesti
r
eneededaf
t
D
epartmento
f
m
erSatisfac
t
w,Goals,an
d
e
yourlevel
o
e
ninglawan
d
theState
e
ninglaw.
heState
e
ninglaw.
r
ingscreenin
g
nMichigan.
the136
he136goal
g
esdoyoufa
c
eelaretheb
a
n
tdoesnotp
a
o
gramtoens
u
t
ive
Effective
NotEffectiv
e
v
e
E
ffective
onsdoyouh
t
ertheinitial
onsdoyouh
t
erscreening
onsdoyouh
t
ertheinfan
t
f
Community
t
ionSurvey2
0
d
Guidelines
o
fagreement
d
EHDINatio
n
Strongly
Disagre
e
g
s.
c
einmeeting
a
rrierstoear
a
sstheheari
n
u
retheinfan
t
e
aveforimpr
o
screenand
p
aveforimpr
o
andpriorto
aveforimpr
o
isdiagnosed
Health
0
12
withthefoll
o
n
al136goal
e
Disagree
theEHDI1
3
lyhearingde
n
gscreen,ho
t
receivesne
c
o
vingthesys
t
p
riortother
e
o
vingthesys
t
diagnosticte
o
vingthesys
t
andpriorto
o
wingstate
m
s:
Somewhat
Disagree
3
6goals?
tectionfori
n
weffectivea
c
essaryfollo
w
t
emforfollo
w
e
screen?
t
emforfollo
w
e
sting?
t
emforfollo
w
enrollmenti
m
entsregardi
n
Somewhat
Agree
n
fants?
rethemeth
o
w
upservices
?
w
upwhena
d
w
upwhena
d
w
upwhena
d
ntoearlyint
e
n
gtheState
Agree St
r
A
g
o
dsusedbyt
h
?
d
ditionalser
v
d
ditionalser
v
d
ditionalser
v
e
rvention?
r
ongly
g
ree
h
e
v
ices
v
ices
v
ices
32
3
10.
W
s
c
11
.
W
a
n
StateEH
D
12. H
E
13
. H
14
. I
s
15
.
W
c
u
16
. H
17
.
D
[I
Michigan
D
EHDICusto
m
W
hatmethod
s
c
reeningand
W
hatmethod
s
n
d/ordiagno
D
IProgram
owdoyouc
u
H
DI?(Please
Fax
Electronic
a
Mail
Other(ple
a
owsatisfied
a
VerySatisf
Satisfied
Somewhat
Somewhat
Unsatisfie
d
Veryunsat
s
thereanyth
i
W
hattypesof
u
rrentlynot
p
owoftendo
Haveneve
r
Lessthan
o
Onceamo
Twotothr
e
Fourtofiv
e
Morethan
o yo ufind th
Yes
f
no]Howco
D
epartmento
f
m
erSatisfac
t
s
couldbeut
i
furtherfollo
w
s
couldbeut
i
stictestresu
u
rrentlysub
m
checkalltha
t
a
lly(byemail
)
a
sespecify):
_
a
reyouwith
ied
Satisfied
unsatisfied
d
isfied
ngEHDIcan
d
technicalas
s
p
rovided,ifa
n
youaccesst
h
r
accessedth
o
nceamont
h
nth
e
etimesam
o
e
timesamo
n
fivetimesa
m
eEHDIwebs
i
No
uldtheuser
f
f
Community
t
ionSurvey2
0
i
lizedtoaddr
w
updoesn
o
i
lizedtoaddr
ltsarenotre
m
ithearingsc
t
apply.)
)
_
__________
_
theprocess
f
d
otoimprov
s
istancewoul
n
y?
h
eEHDIweb
s
ewebsite[s
k
h
o
nth
n
th
m
onth
i
teuserfrien
d
f
riendliness
o
Health
0
12
e
ssLosstoF
o
o
toccur)?
e
ssLosstoD
o
p
ortedtoEH
D
reening/testi
_
_________
_
f
orsubmittin
g
etheproces
s
dyouliketo
s
ite(www.mi
c
k
iptoquestio
d
ly?
o
fthewebsit
e
o
llowup(inf
a
o
cumentatio
DI)?
i
ngresults(i
n
_
________
g
hearingscr
e
s
ofsubmitti
n
seetheEHDI
c
higan.gov/e
n19]
e
beimprove
d
a
ntsthatdon
n(infantsw
h
n
itial,rescree
n
e
eningresult
s
n
ghearingsc
r
programpr
o
hdi)?
d
?
’tpassthe
h
osescreenin
n
s,diagnosti
c
s
?
r
eeningresul
t
o
videthatis
g
c
) to
t
s?
  33
4
18. I
s
[I
19. P
u
s
E
H
T
h
E
A
20.
W
i
n
21. P
r
e
M
H
P
E
M
G
N
S
e
H
R
S
c
M
M
R
Michigan
D
EHDICusto
m
s
thereinfor
m
Yes
f
yes]Whati
n
leaseindicat
e
s
efulyoufin
d
H
DIQuarterl
y
ospitalNews
h
eAudioGr
a
H
DINewsfo
r
udiologists
W
hatinforma
t
n
cluded?
leaseindicat
e
e
ceive,how
u
M
ichigan’sNe
w
earingScree
n
rogramBroc
h
H
DIOnlineT
r
M
odule
uidelinesfor
ewbornHea
r
e
rvices
earingScree
n
esultsCribC
a
c
reenerScrip
M
onthly
M
issing/Inco
m
eport
D
epartmento
f
m
erSatisfac
t
m
ationyou’d
l
No
n
formation
w
e
whichnew
s
d
them.
D
o
Re
y
Birth
letter
a
m:
r
t
ionwouldy
o
e
whichmat
e
u
sefulyoufin
d
Do
Re
c
w
born
n
ing
h
ure
r
aining
r
ing
n
ing
a
rd
t
m
plete
f
Community
t
ionSurvey2
0
l
iketoseead
w
ouldyoulik
e
s
lettersyour
e
o
Not
ceive
Not
a
all
Usef
o
uliketosee
e
rialsandres
o
d
them.
Not
c
eive/Use
N
a
U
Health
0
12
dedtotheE
H
e
toseeadde
d
e
ceivefrom
E
a
t
u
l
Somew
NotUs
e
inthenewsl
e
o
urcesyouu
t
N
otat
a
ll
U
seful
Som
Not
H
DIwebsite?
dtotheweb
s
E
HDI,andfor
hat
e
ful
Not
Useful
e
ttersyoure
c
t
ilizefromEH
ewhat
Useful
Not
Use
f
s
ite?
thoseyoud
o
Somewhat
Useful
c
eivethatis
n
DI,andfort
h
f
ul
Somew
h
Useful
o
receive,ho
w
Useful
V
U
n
otcurrently
h
oseyoudo
h
at Useful
w
V
ery
U
seful
Very
Useful
34
5
C
R
H
L
o
S
e
W
H
G
a
n
G
B
S
a
V
R
M
I
m
R
22.
W
23. A
24. [I
[I
25. P
a
n
E
c
o
E
a
c
E
k
n
Michigan
D
EHDICusto
m
ommunicati
n
esults
andsandVo
i
o
ssandFoun
e
rvicesforC
h
W
hoareDeaf
ardofHeari
n
uideforFam
n
dProviders
uideByYour
rochure
a
mpleLetter
s
iewingHeari
n
esultsinthe
M
ichiganCare
m
provement
egistry(MCI
R
W
hatotherm
a
reyouawar
e
Yes
f
yes]Doyou
Yes
f
no]Whati
m
leaseindicat
e
n
dtheMDC
H
H
DIprogram
o
urteous/res
H
DIprogram
c
cessible.
H
DIprogram
n
owledgeabl
e
D
epartmento
f
m
erSatisfac
t
n
gRefer
i
ces
dDVD
h
ildren
or
n
g:A
ilies
Side
s
n
g
R
)
a
terialsorre
s
e
ofthepare
n
No[Ski
p
feelthepar
e
No
m
provement
s
e
yourlevel
o
H
:
staffare
pectful.
staffare
staffare
e
.
f
Community
t
ionSurvey2
0
s
ourceswoul
n
tsupportpr
o
p
toquestion
e
ntsupport
p
s
wouldyous
o
fagreement
Strongl
y
Disagre
Health
0
12
dyouliketo
o
gramsprovi
d
25]
p
rogramsoff
e
uggestforth
e
withthefoll
o
y
e
Disagre
e
seemadeav
a
d
edbyEHDI
?
e
redbyEHDI
a
eparentsup
p
o
wingstate
m
e
Somewh
a
Disagree
a
ilable?
?

areadequat
e
p
ortprogra
m
m
entsaboutS
at Somew
Agree
e
?
m
s?
tateEHDIst
a
hat Agree
a
ff
Strongly
Agree
  35
6
E
h
E
r
e
E
a
d
a
s
O
t
h
T
h
m
O
m
M
26. If
a
r
27.
W
28. I
s
Thankyo
u
Again,if
y
[InsertN
a
[InsertE
m
[InsertTe
Michigan
D
EHDICusto
m
H
DIprogram
e
lpful.
H
DIprogram
e
sponsive.
H
DIprogram
d
equatetec
h
s
sistance.
O
verall,Iams
h
eEHDIprog
r
h
isMDCHpr
o
m
yservicene
e
O
verall,Iams
m
yexperienc
e
M
DCHprogra
m
youarenot
s
r
eunsatisfie
d
W
hatcouldth
s
thereanyth
i
u
forcomple
t
y
ouhaveany
a
me]
m
ailAddress]
lephoneNu
m
D
epartmento
f
m
erSatisfac
t
staffare
staffare
staffprovid
e
h
nical
atisfiedwith
r
am.
o
grammeets
e
ds.
atisfiedwith
e
withthis
m
.
s
atisfiedwit
h
d
:
eEHDIprogr
a
ngelseyou
w
t
ingthissurv
e
questionsor
m
ber]
f
Community
t
ionSurvey2
0
e
h
yourexperi
e
a
mdotobet
t
w
ouldliketo
t
e
y!
commentsr
e
Health
0
12
e
ncewiththi
s
t
erserveyo
u
t
ellus?
e
gardingthis
s
MDCHprog
u
?
survey,plea
s
ram,please
s
s
econtact:
s
pecifywhy
y
y
ou
36
3. Michigan’s Online Public Health Dental Prevenon Program Sasfacon Survey  


TheMich
i
program
s
efficiency
,
SurveyIn
t
Michigan
program
a
orderto
b
appreciat
response
s
identifiab
declinet
o
Wewoul
d
Ifyouha
v
[InsertN
a
[InsertE
m
[InsertTe
Thankyo
u
Survey
DateSur
v
Demogra
p
1. P
Michigan
D
PA161Pro
g
Michiga
n
M
i
ganDepart
m
s
thatareres
p
,
andservice
t
roduction
sPA161:Pu
a
nditsproce
s
b
etterserve
y
eyourtime
a
s
willbefully
lebyyouran
o
answerany
d
appreciate
y
v
eanyquesti
o
a
me]
m
ailAddress]
lephoneNu
m
u
!
v
eyComplete
p
hicInforma
t
leaseindicat
e
Communit
y
FQHC(Fed
LongTerm
NonProfit
PrisonSys
t
PublicHea
Schoolof
D
Schoolba
s
Other,ple
a
D
epartmento
f
g
ramSuppor
t
n
Departme
n
M
ichigan’sP
A
m
entofCom
m
p
onsivetocu
s
quality,wee
n
b
licHealthD
e
s
sesfromag
e
y
ou.Weenc
o
a
ndfeedback
confidential,
swers.Your
p
questionwit
h
y
ourrespons
o
nsaboutthi
m
ber]
d:________
_
t
ion
e
thetypeof
y
DentalClini
erallyQualifi
e
CareFacility
/
Agency
t
emorJuveni
lthAgency
D
entistryor
D
s
edorSchool
a
sespecify:_
_
f
Community
t
Survey201
2
n
tofCommu
n
A
161:Public
Progra
m
m
unityHealth
s
tomerneed
s
n
courageyo
u
e
ntalPreven
t
e
nciesenroll
e
urageyouto
.Thesurvey
w
resultswill
o
p
articipation
h
outanyrisk
e
by[enterd
a
ssurvey,ple
a
_
_________
_
agencyyour
e
c
e
dHealthCe
n
/
NursingHo
m
leDetention
D
entalHygien
linkedHealt
h
_
_________
_
Health
2
n
ityHealth
HealthDent
a
m
SupportSu
r
(MDCH)stri
v
s
.Tomaintai
n
u
toshareyo
u
t
ionProgram
e
dinPA161,
taketimeto
w
illtakeapp
r
o
nlyberepor
t
inthissurve
y
toyou.
a
tebywhich
a
secontact:
_
_____(MM/
e
present.
n
ter)
m
e
Center
e
h
Center
_
_________
_
PublicHealt
a
lPreventio
n
r
vey
v
estoprovid
e
n
orimprove
c
u
rthoughts,
i
isinterested
toidentifya
n
completeth
i
r
oximately1
0
t
edinaggreg
y
iscomplete
l
youwouldli
k
/
DD/YYYY)
_
_________
t
hAdministr
a
n
Program
e
highqualit
y
customersa
t
i
deas,andfe
e
inreceiving
f
n
dmakeimp
r
issurveyand
0
minutesto
c
ate,andyou
lyvoluntary
a
k
etoreceive
a
tion
y
servicesan
d
t
isfaction,
e
dback.
f
eedbackon
t
r
ovementsin
sincerely
c
omplete.Yo
willnotbe
a
ndyouaref
r
responses].
d
the
ur
r
eeto
  37
2. I
n
Prog
r
3. P
a
p
T
h
s
t
a
r
T
h
i
n
c
o
T
h
i
n
f
o
T
h
c
o
T
h
a
n
f
r
P
A
a
v
q
a
p
O
t
h
p
4. R
5.
W
Michigan
D
PA161Pro
g
n
whatcount
y
r
amApplicati
o
leaseindicat
e
p
plicationpr
o
h
eapplicatio
t
epapplicati
o
r
eeasytoob
t
h
estepbyst
n
structionsa
r
o
mprehensiv
h
estepbyst
n
structionsa
r
o
llow.
h
eapplicatio
o
mplete.
h
eprocessf
o
n
application
r
iendly.
A
161progra
v
ailabletoa
n
uestionsreg
a
p
plicationpr
o
O
verall,Iams
h
ePA161ap
p
rocess.
emindersre
g
StronglyA
g
Agree
Somewhat
Somewhat
Disagree
StronglyD
i
NotApplic
a
W
hatcanthe
P
D
epartmento
f
g
ramSuppor
t
y
orcounties
o
n
e
yourlevel
o
o
cess:
nandstepb
y
o
ninstructio
n
t
ain.
epapplicatio
r
e
e.
epapplicatio
r
eeasyto
niseasyto
o
rsubmitting
isuser
mstaffare
n
swer
a
rdingthe
o
cess.
atisfiedwith
p
lication
g
ardingthen
e
g
ree
Agree
Disagree
i
sagree
a
ble
P
A161progr
f
Community
t
Survey201
2
doyouprovi
o
fagreement
Strongly
Disagre
e
y
n
s
n
n
e
edforappli
c
amdotoim
p
Health
2
deservices?
withthefoll
o
e
Disagree
c
ationrenew
a
p
rovetheap
p
o
wingstate
m
Somewhat
Disagree
a
larehelpful
p
licationpro
c
m
entsregardi
n
Somewhat
Agree
.
c
ess?
n
gthePA16
1
Agree St
r
A
g
1
r
ongly
g
ree
38
6. I
s
p
Quarterl
y
7. P
q
T
h
i
n
f
o
T
h
t
o
T
h
q
f
r
D
r
e
Q
a
r
P
A
a
v
q
q
O
t
h
p
8.
D
w
9. I
s
r
e
PA161P
r
10. H
Michigan
D
PA161Pro
g
s
thereanyth
i
rocess?
y
Repor
t
leaseindicat
e
uarterlyrep
o
h
equarterly
r
n
structionsa
r
o
llow.
h
equarterly
r
o
complete.
h
eprocessf
o
uarterlyrep
o
r
iendly.
istributiono
f
e
porttempla
t
Q
uarterlyrep
o
r
ehelpful.
A
161progra
v
ailabletoa
n
uestionsreg
a
uarterlyrep
o
O
verall,Iams
h
ePA161qu
a
rocess.
oyouhavea
w
hatarethe
b
s
thereanyth
i
e
portproces
s
r
ogramOver
a
owoftendo
Lessthan
o
Onceamo
Twotothr
e
Fourtofiv
e
Morethan
D
epartmento
f
g
ramSuppor
t
ngelseyou’
d
e
yourlevel
o
o
rtprocess:
r
eport
r
eeasyto
r
eportiseas
y
o
rsubmitting
o
rtisuser
f
thequarterl
t
eisadequat
o
rtreminder
s
mstaffare
n
swer
a
rdingthe
o
rtprocess.
atisfiedwith
a
rterlyrepor
t
nybarrierst
o
b
arrierstopr
o
ngelseyou’
d
s
?
a
l
l
youaccesst
h
o
nceamont
h
nth
e
etimesam
o
e
timesamo
n
fivetimesa
m
f
Community
t
Survey201
2
d
liketoshar
e
o
fagreement
Strongly
Disagre
e
y
a
y
e
.
s
t
o
providingt
h
o
vidingcomp
d
liketoshar
e
h
ePA161pa
g
h
o
nth
n
th
m
onth
Health
2
e
withthePA
withthefoll
o
e
Disagree
h
einformatio
leteinforma
t
e
withthePA
g
eontheora
161progra
m
o
wingstate
m
Somewhat
Disagree
nrequested
t
ionontheq
u
161progra
m
lhealthweb
s
m
regardingt
h
m
entsregardi
n
Somewhat
Agree
bythequart
e
u
arterlyrep
o
m
regardingt
h
s
ite?
h
eapplicatio
n
n
gthePA16
1
Agree St
r
A
g
e
rlyreport?I
f
o
rt?
h
equarterly
n
1
r
ongly
g
ree
f
so,
  39
11.
D
[I
12. I
s
[I
13.
W
c
u
14.
W
p
15. P
a
n
P
A
c
o
P
A
a
c
P
A
k
n
P
A
h
P
A
r
e
P
A
p
a
s
O
t
h
T
h
m
O
m
M
Michigan
D
PA161Pro
g
oyoufindth
Yes
f
no]Howco
s
thereinfor
m
Yes
f
yes]Whati
n
W
hattypesof
u
rrentlynot
p
W
hattypesof
rovided,ifa
n
leaseindicat
e
n
dtheMDC
H
A
161progra
o
urteous/res
A
161progra
c
cessible.
A
161progra
n
owledgeabl
e
A
161progra
e
lpful.
A
161progra
e
sponsive.
A
161progra
rovideadeq
u
s
sistance.
O
verall,Iams
h
ePA161pr
o
h
isMDCHpr
o
m
yservicene
e
O
verall,Iams
m
yexperienc
e
M
DCHprogra
m
D
epartmento
f
g
ramSuppor
t
ePA161pa
g
No
uldtheuser
f
m
ationyou’d
l
No
n
formation
w
thetechnica
p
rovided,ifa
n
materialsw
o
n
y?
e
yourlevel
o
H
:
mstaffare
pectful.
mstaffare
mstaffare
e
.
mstaffare
mstaffare
mstaff
u
atetechnica
l
atisfiedwith
o
gram.
o
grammeets
e
ds.
atisfiedwith
e
withthis
m
.
f
Community
t
Survey201
2
g
euserfrien
d
f
riendliness
o
l
iketoseead
w
ouldyoulik
e
lassistance
w
n
y?
o
uldyoulike
t
o
fagreement
Strongly
Disagre
e
l
Health
2
ly?
o
fthepageb
e
dedtotheP
A
e
toseeadde
d
w
ouldyoulik
e
t
oseetheP
A
withthefoll
o
e
Disagree
e
improved?
A
161page?
dtothepag
e
e
toseethe
P
A
161progra
m
o
wingstate
m
Somewha
Disagree
e
?
P
A161progr
a
m
provideth
a
m
entsaboutS
t Somew
h
Agree
a
mprovidet
h
a
tarecurrent
tatePA161
S
h
at Agree
h
atis
lynot
S
taff
Strongly
Agree
40
16. If
a
r
17.
W
18. I
s
Thankyo
u
Again,if
y
[InsertN
a
[InsertE
m
[InsertTe
Michigan
D
PA161Pro
g
youarenot
s
r
eunsatisfie
d
W
hatcouldth
s
thereanyth
i
u
forcomple
t
y
ouhaveany
a
me]
m
ailAddress]
lephoneNu
m
D
epartmento
f
g
ramSuppor
t
s
atisfiedwit
h
d
:
ePA161pro
ngelseyou
w
t
ingthissurv
e
questionsor
m
ber]
f
Community
t
Survey201
2
h
yourexperi
e
gramdotob
w
ouldliketo
t
e
y!
commentsr
e
Health
2
e
ncewiththi
s
etterservey
o
t
ellus?
e
gardingthis
s
MDCHprog
o
u?
survey,plea
s
ram,please
s
s
econtact:
s
pecifywhy
y
y
ou


| 
| 
