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East Midlands Strategic Health Authority
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Users Questionnaire

Template for user to seek views from Supervisors of Midwives

1

How do you involve women using the service in service and policy development?

2

How do you measure the quality of the maternity services?

3

What service improvements have you developed /identified as being required?

4

What are the barriers, if any, to how you plan to overcome them?

Date:

Supervision of Midwives Audit (survey)

Template for letter to users re audit of Supervisor of Midwives

We have been asked to review the service our Supervisors of Midwives offer within our Maternity department and as part of this we would like to know if you have been given information about the Supervisor of Midwives or if you have ever contacted a Supervisor of Midwives.

You do not have to take part in this survey but we would value your views if you feel able to comment and we would appreciate you reading the questions to see if you would like to take part.

If you decide to take part:

·         We would like you to be open and honest in your answers as you answer the questionnaire

·         The information you give will be confidential and cannot be linked back to you individually ( unless you request this ).

·         The information you give will be used to see whether we need to make improvements in our current service

If you would like any further information about this survey please contact XXXX on XXXX

If you are able to complete this questionnaire could you please return it to any member of staff.

Thank you

Supervisor of Midwives

Users Audit Questionnaire

1.     Have you been given information about the service that a Supervisors of Midwives offer?

         Yes                     No

2     Did you know that a Supervisor of Midwives supports a midwife in his/her practice?

         Yes                     No

3        Did you know that a Supervisor of Midwives has a legal responsibility to ensure the safety of you and your baby?


Yes                        No

4        Did you know that as well as having support and information from your midwife, a Supervisor of Midwives:

a)      is available to you to offer guidance and support?

Yes                     No

b)     can be contacted day or night?

Yes                     No

c)      can act as an advocate for you (assist you in presenting your views and choices)?

Yes                     No

d)     can give you information about the risks and benefits associated with care options and choices?

Yes                     No

e)     can give you information about the complaints process?

Yes                     No

5        Did you know that as well as talking to a Supervisor of Midwives that you can also speak directly to the Supervisor at the Strategic Health Authority if you wish to discuss any aspect of your care?

Yes                  No

6        Have you ever contacted a Supervisor of Midwives about your care?

Yes                  No

7        Do you have any additional comments?


Adopted with the permission of the south of England LSAMO