Usertick
Start free
Care coordination survey template

See where handoffs break, through the patient's eyes

Four questions for after care that crossed departments: how well the teams worked together, whether patients had to repeat themselves, whether they knew who was in charge and where things fell through the cracks. Use it as it is or change any question, and Usertick reads every written answer for you.

Get started freeAll templates

What this care coordination survey tells you

A care coordination survey asks patients whether the teams around them worked as one: whether departments shared what they knew, whether the patient had to tell the same story twice and whether someone was clearly in charge. This template asks four questions in under a minute and ends with where things fell through the cracks.

It is written for after care that involved more than one department, such as a hospital stay with several services or a referral between clinics, sent by Usertick email once that care has ended. The same survey runs as a link in your own follow-up emails or as a QR code on the visit summary.

Results shows the average on the teamwork scale with a column per step, and the share who said yes to repeating their information and to knowing who was in charge. The written answer is read as it arrives and filed under a category such as staff and communication or records and privacy, with a type and an urgency.

In an emailAs a linkOn your websiteAs a conversation
Questions
4
Time to answer
About a minute
Written for
After care that involved more than one department, by email
Plans
Every plan, the free plan included

See it on every channel

The same template on your website, behind a link, in an email and as a conversation.

In an email

Send it from Usertick to a contact list, and a button in the email opens the survey on its own page. Usertick sends 50 emails a month on the free plan, or connect your own sender.

The 4 questions, one by one

What each question asks, why it is there, what it shows you and what to change.

Question 1 of 4 · Big scale

How well did the different teams work together on your care?

Why ask it
Patients see the handoffs between teams that no single department sees. A 1 to 10 scale from not at all to very well gives one number for how joined-up the care felt.
What you learn
The average and a column per step from 1 to 10, compared with the period before. Select the low columns to see whether those patients also had to repeat their information.
Make it yours
In the email, a big scale shows as a button that opens the survey; move a yes or no question first when you want the first answer inside the message.
Question 2 of 4 · Yes / No

Did you have to repeat your information to different people?

Why ask it
Telling the same story to several people is the clearest sign that information didn't travel between teams, and patients notice it every time.
What you learn
The share that said yes, against the period before. Here a lower share is better, so watch it fall after a change to how teams hand over.
Make it yours
Read the written answers of patients who said Yes to find which handoff lost the information.
Question 3 of 4 · Yes / No

Did you always know who was in charge of your care?

Why ask it
A patient who knows who leads their care knows who to ask. A No points to a missing named contact for the patient.
What you learn
The share that said yes, compared with the period before. Select No to see how those patients rated teamwork.
Make it yours
When the share is low, give each patient one named coordinator and write the name on their paperwork, then watch this share in the next period.
Question 4 of 4 · Text · Optional

Where did things fall through the cracks?

Why ask it
Asking where things fell through the cracks brings out the specific gap: a message that never arrived, a form filled in twice, an appointment that waited on another team.
What you learn
Each answer with its sentiment and theme, filterable by theme, with up to 8 themes and their trends. Usertick also marks each one as a complaint, an idea or praise and flags the urgent ones.
Make it yours
Use the placeholder to ask about handoffs, messages and scheduling, and to leave out diagnoses.

What the answers show

Results turns each question into numbers you can follow week by week.

Every written answer, read for you

Each answer arrives with its category, theme, type and urgency, so the urgent ones reach your team first.

Use this template in four steps

From the template to the first answers.

  1. 1

    Open the template

    Sign up free and pick Care coordination in the template gallery. It opens in a matching style, ready to change.

  2. 2

    Make the questions yours

    Reword any question, change the options, and add logic or more questions.

  3. 3

    Choose where it runs

    Show it on your website, send it by email, share its link and QR code, or switch it to a conversation.

  4. 4

    Publish and read the answers

    Answers arrive in Results and the inbox as people send them, each written one read and filed by Usertick.

Tips for this survey

Small choices that keep people answering and the answers useful.

  1. 01

    Send it when the episode ends

    Wait until the last department has finished, so patients can judge every handoff. Usertick doesn't send on its own when care ends, so schedule the send or add the link to your own follow-up email.

  2. 02

    List the departments involved

    Add a multiple choice question that lists the departments the patient saw, so you can select each one in Results and read the answers of its patients.

  3. 03

    Share each gap with both teams

    When an answer names a handoff between two teams, give it one owner in the inbox and add notes on what each team will change.

  4. 04

    Keep diagnoses out

    Ask about teamwork, information and who was in charge, never the illness or the treatment. Usertick's terms don't allow health records or medical details in surveys, and Usertick doesn't sign business associate agreements.

Customer effort scorePatient satisfaction surveysEmail surveysMaternity care questions

More customer effort templates and questions

Templates like this one, and single questions from the library to add to it.

Templates

Browse all templates
Customer effortTelehealth visitFind out how easy it was to join a video visit and whether patients would choose one again. Send it right after the call ends.
Customer effortPatient portalMeasure how easy your patient portal is to use and whether people could finish what they came to do. Show it after a patient logs out.
Customer effortLab testMeasure the lab experience from booking to results, including waits at the lab. Send it once results are released.
Customer effortVaccination clinicLearn how easy it was to get an appointment, how long people waited and whether aftercare information was clear. Send it the day after the appointment.

Questions from the library

Browse the question library
  1. Split 100 points across what mattered most in your carePoints allocation · Maternity care
  2. Did you have a birth plan you could talk through?Yes / No · Maternity care
  3. Were your questions answered without you having to push?Yes / No · Maternity care
  4. How easy was it to get your referral moving?Customer effort · Referrals and specialists
  5. How many days passed before the specialist contacted you?Ruler · Referrals and specialists
  6. Did you know who to chase while you waited?Yes / No · Referrals and specialists

Frequently asked questions

After the care that crossed departments has ended, such as a few days after discharge or after the last visit in a series. Usertick sends email now or at a time you schedule up to 30 days ahead.

Patients whose care involved more than one department or clinic. Import them as contacts with an email and a name per line, or share the link in your own follow-up email.

Four is enough to find the gaps without tiring patients. This template asks four and takes under a minute.

A high teamwork score, a low share who had to repeat their information and a high share who knew who was in charge. Compare each with the period before to see whether a change worked.

No. Usertick's terms don't allow health records or medical details in surveys and Usertick doesn't sign business associate agreements, so the questions stay on teamwork, information and who was in charge.

Yes. Every template comes with every plan, the free plan included, and the free plan covers 150 responses a month across your surveys.

Yes. The template becomes your own survey, so reword any question, add or remove questions, and change the options and the logic. The gallery stays as it is.

Yes, from Starter. The template is written in US English. Add languages by hand or with AI translation, and each person sees the survey in their browser's language.

Listen better, act faster, and build what truly matters.

Start free, see what your customers mean, and get each answer to the person who can act on it.

Get started freeTalk to sales
  • 150 responses a month on Free
  • Every channel and AI analysis
  • No card needed