Toronto Palliative Care Network - Survey of Agencies

Toronto Palliative Care Network
Survey of Agencies

The Toronto Palliative Care Network (TPCN) is a Toronto-based network of 32 hospices, hospitals and community service organizations working to facilitate the development of a comprehensive, integrated and coordinated system of palliative care for Toronto. TPCN has initiated a project to review its mandate and priorities and determine the best organizational model for the long-term sustainability of the network. Part of this process involves gathering information from organizations who are not TPCN members but who may have some interest or role in palliative or end-of-life care.

We need your help. Please complete this questionnaire (delivered directly to the project consultant) no later than Monday, September 24, 2007. You will have a chance to edit your responses after you "Submit" your survey. Your replies will be combined with responses from other agencies and will remain anonymous and confidential.

If you are unsure, or don't know the answer to a particular question, simply leave that item blank.

Please provide the following background information about your organization.

Name of Agency or Provider:

Type of Organization: (Check all that apply)

Association
Community Health Centre
Family Health Team
Home Care Provider
Long-term Care Home
Supportive Housing
Other (please specify):

Approximately what percentage of your organization's service would involve some form of palliative or end-of-life care?
% (Give your best estimate)

Is your organization a member of any health or social services networks?
Yes No

Which ones?

Some broad external factors affecting the health and social services field are listed below. Review the list and rank each item in terms of its impact on palliative and end of life care in Ontario. Assign a "1" to the most significant factor, a "2" to the next factor, and so on down to "7".

Insert ranks from 1 to 7.

Funding uncertainties
The government's health transformation agenda
Availability of community resources
Recruiting and retaining qualified staff
Changing demographics
Changing public attitudes
More informed and demanding consumers

3.	Are there any other significant trends, issues or events that should be considered as TPCN reviews its structure and mandate?

4.	Prior to receiving this questionnaire were you aware of TPCN?
	Yes No (go to question 6)

The current mission statement of TCPN reads as follows:

"The Toronto Palliative Care Network will provide leadership and structure to facilitate the development of a comprehensive, integrated and coordinated system of palliative care for Toronto."

In general, how would you rate our overall effectiveness in pursuing this mission?

Very effective	Not too effective
Somewhat effective	Not at all effective
Don't Know/No Opinion
Please give the reason for your rating:

Some of the products and services TPCN offers or is considering offering to its members are listed below. Please review the list and rate each item's potential usefulness to your particular organization: (If you are unsure, or don't know, leave the item blank.)

	Very useful	Somewhat useful	Not too useful	Not at all useful
Website listing member agencies, services available and referral process
Common referral form for palliative care
Common client assessment form
Norms and standards of practice
Audit tool for service evaluation
Competencies for palliative care providers
Access to a registry of palliative care beds
Palliative and end of life care educational opportunities

7.	Are there any other products or services related to palliative and end of life care that could be of use to your organization?

Organizations that join networks usually experience both costs (membership fees, time commitments, etc.) as well as benefits (networking, coordination, education, etc.)

What would be the main costs and benefits of any network membership for your organization?

Costs

Benefits

What would be the likelihood of your organization joining or having some kind of formal affiliation with TPCN?

Not at all likely - Why is that? (Please specify below)

Not too likely

Somewhat likely

Very likely

Why is it "Not at all likely"?

10.	Feel free to make any additional suggestions regarding the TPCN or palliative care services in general

Completed by:

Name:
Title:

If necessary, may the consultant contact you directly for clarification or elaboration?

Yes (Please complete Contact Information below)
No

Contact Information

Phone:
Email:

Thank you for your cooperation.