Surgery Feedback Template: Collecting Patient Feedback

A surgery feedback template collects a patient's view of the whole surgical journey, from the first consultation and consent to the operation day, pain control, discharge and recovery. Asking these stages separately tells the surgical team where the experience broke down, which a single satisfaction score cannot. For the general case for collecting patient feedback, see our hospital feedback form template; this article covers two ready surgery forms, stage-by-stage questions and how to use the results.

Top Surgery Feedback Template Examples

Example 1: Surgery Feedback Form With Graded Answers

A one-page form for the patient to fill in after surgery, before discharge or at the first follow-up. Each question has its own five-step answer scale, and the last is a comment box for suggestions. It starts with name and date.

1. How satisfied were you with the overall care and attention provided by the surgical team? (Not satisfied / Somewhat satisfied / Satisfied / Very satisfied / Extremely satisfied)
2. Did you feel adequately informed about the surgery, including potential risks and benefits? (Not informed / Somewhat informed / Adequately informed / Well informed / Fully informed)
3. How would you rate the communication and responsiveness of the medical staff during your surgery and recovery? (Poor / Fair / Good / Very good / Excellent)
4. Were your pain management needs met during your hospital stay? (Not met / Partially met / Adequately met / Well met / Fully met)
5. Do you have any suggestions for improving the surgical experience for future patients? (comment)

Example 2: Short Surgery Feedback Form With a Smiley-Face Scale

The first four questions of Example 1, each answered on one five-point face scale under the instruction "On a scale of 1 to 5, how satisfied or dissatisfied are you with our services or products?" It has no suggestions box, so it is quicker for a patient who is still recovering but gives you no comments.

• Name and date
• Answer scale for every question: (Bad / Poor / Average / Good / Excellent)
• Questions: overall care and attention from the surgical team; whether you felt adequately informed about the surgery, including risks and benefits; communication and responsiveness of medical staff during surgery and recovery; whether your pain management needs were met

Key Components of an Effective Surgery Feedback Template

Group questions by stage, so a low score points to the team responsible. Pick two or three from each stage.

1. Pre-Surgery Information

• Did the surgeon explain why you needed the operation and what the alternatives were? (Yes / Partly / No)
• Were the risks and benefits explained before you signed the consent form? (Yes / Partly / No)
• Were the instructions for before surgery (fasting, medicines, arrival time) clear? (1 to 5)
• Did you know roughly what recovery would involve? (Yes / Partly / No)

2. Surgical Experience

• How long did you wait on the day before going to theatre, and were you told about any delay? (Under 1 hour / 1 to 3 hours / Over 3 hours; Yes / No)
• Did staff check your details and explain what would happen next? (Yes / No)
• Was your pain well controlled after the operation? (Not met / Partially met / Fully met)
• Were your privacy and dignity respected? (1 to 5)

3. Post-Operative Care

• Were wound care, medicines and activity limits explained before you went home? (1 to 5)
• Did you know which warning signs to watch for and whom to call? (Yes / No)
• Was your follow-up appointment easy to arrange? (1 to 5)
• How satisfied are you with your recovery so far? (1 to 5)

4. Additional Comments

• What went well that we should keep doing? (comment)
• What one thing would have made your surgery experience better? (comment)

Designing a User-Friendly Surgery Feedback Template

• Plain language: "the operation" and "the theatre", not procedure codes or medical terms.
• Short: patients recovering from surgery tire quickly. Ten to twelve questions is plenty; split pre-discharge and recovery questions into two short forms if you need both.
• Mixed question types: rating scales for tracking, yes/no for facts such as "was a delay explained", and one or two comment boxes.
• Anonymous by default: patients may worry that criticism will affect their follow-up care. Make name optional and say so on the form.
• Paper and digital: paper suits elderly patients and those without internet access but needs manual data entry; a link by SMS or email is quicker to analyse. Offer both.
• Test it: try the form with a small group of patients and revise unclear questions before rolling it out.

When To Ask for Surgery Feedback and How To Encourage Responses

• Before discharge: pre-surgery and surgery-day questions, while details are fresh.
• At or after the first follow-up: recovery questions, once the patient knows how recovery is going. For day-case surgery, send one combined link a day or two after the operation.
• Explain why: tell patients their answers will be used to improve care for future patients and will not affect their own treatment.
• Remind once: if a patient has not responded within a week or two, send one polite reminder.
• Brief staff: ward nurses and the surgeon's team should mention the form at discharge.

Discharge itself is covered in more detail in our discharge process feedback template.

Analyzing and Utilizing Surgery Feedback

• Sort by stage and team: group responses into pre-surgery, surgery day and post-operative care, and by procedure or surgical unit where numbers allow.
• Look for trends: if several patients report poor pain control or unclear wound-care instructions, review that protocol rather than single cases.
• Who sees it: the ward or theatre nurse in charge sees comments weekly; the head of surgery and the quality team review monthly trends and agree action plans.
• How fast to act: treat any comment suggesting a complication, an infection or a safety concern as a clinical matter and pass it to the treating team the same day. Contact patients who raised a specific concern; see our guide to handling patient complaints in hospitals.
• Share and monitor: share results and action plans with the whole surgical team, then check whether later feedback improves.
• Review the form yearly: drop questions that never show a problem and add ones for new services.

Frequently Asked Questions