1 Start 2 Complete

Learner Demographics *

Physician

Nurse

Other

Overall Series Rating *

	Excellent	Satisfactory	Poor
Overall, how would you rate this series?	Overall, how would you rate this series? - Excellent	Overall, how would you rate this series? - Satisfactory	Overall, how would you rate this series? - Poor

Extent to which identified Series objectives were met: I am better able to ... *

	Outstanding	Good	Satisfactory	Fair	Poor
Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes.	Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes. - Outstanding	Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes. - Good	Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes. - Satisfactory	Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes. - Fair	Identify measurement methods to improve the division's performance related to quality metrics and patient reported outcomes. - Poor
Assess a system/organization failure and suggested remedies.	Assess a system/organization failure and suggested remedies. - Outstanding	Assess a system/organization failure and suggested remedies. - Good	Assess a system/organization failure and suggested remedies. - Satisfactory	Assess a system/organization failure and suggested remedies. - Fair	Assess a system/organization failure and suggested remedies. - Poor
Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation.	Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation. - Outstanding	Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation. - Good	Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation. - Satisfactory	Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation. - Fair	Integrate processes to reduce fall outs related to the Joint Commission's Conditions of Participation. - Poor
Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics).	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Outstanding	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Good	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Satisfactory	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Fair	Discuss possible barriers and biases which may impact patient care (i.e., race, ethnicity, language, gender identity/orientation, age, socioeconomic status, attitudes, feelings, or other characteristics). - Poor

Do you believe the subject matter presented/discussed was: *

	Yes	No
Objective	Objective - Yes	Objective - No
Fair & Balanced	Fair & Balanced - Yes	Fair & Balanced - No
Free of Commercial Bias	Free of Commercial Bias - Yes	Free of Commercial Bias - No

Have you made changes to your practice as a result of this series?

Yes

No

Please describe:

Do you have any recommendations for the moderator(s)/facilitator(s) of this series?

Yes

No

Please describe:

The Series included educational components that addressed cultural linguistic competency and implicit bias

Yes

No

N/A (If a research or non-direct patient care series)

Outside of this activity, what additional topics would you like addressed in other educational opportunities?

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