Reflective Template:  Patient Surveys

This reflective template has been designed to use with the SOAR Database (Scottish Online Appraisal Resource).  When you have completed this reflection, please upload it to SOAR / Form 3 and submit it to your interview to share with your Appraiser.	3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and customise the file name (e.g. Patient Survey Reflection 2012)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1), either to the Documents Library, or directly to Form 3.	

This reflection template form should be used for Domain 3: Communication, Partnership and Teamwork.

This template is used for reflecting on a recent Patient Survey which you had done.

The boxes will expand automatically as you type into them.
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Please confirm - Have you had formal feedback from Patients this year?
Please mark with “x” in box
	Yes.	
	No (in which case you should use “Patient and Carer Involvement” instead).	

How do you feel about this?

Your appraiser will need a copy of your survey results to discuss them with you. The aim will be to reflect purposefully on any positive feedback, and on any negative feedback. However you may wish to consider these questions in advance.

What positive features have you identified from the feedback?

What negative features have you identified?

What are the possibilities for addressing any concerns that have been expressed?