Self Assessment Survey

Take this short self-assessment to find out if you could benefit from executive coaching. To test your responses, print a copy of this survey and give it to a member of the board, medical staff or executive team. Compare their answers with yours. Indicate your level of interest in the following: * Required   Strongly Agree   Agree   Disagree   Strongly Disagree I worry about our organization's ability to sustain the success we have achieved. *           Our organization has a hard time maintaining focus and discipline. *         Our organization's energy and will is slipping. *         Our organization is constantly in a response mode. *         When our organization is struggling, it lacks insight into figuring out the problems and solutions. *         I find that our organization's performance is lagging behind the competition. *         I spend too many hours dealing with conflicts I have with board members, medical staff and the executive team. *         I need to develop new skills and competencies to help me meet some of the new challenges facing me. *         I find getting clear and candid feedback from those around me is difficult. *         I often wish I had someone with whom I can openly converse with; to confide in about tough issues. *         I find it increasingly difficult to balance between work and personal life without overtly affecting the performance of the organization. *         Please check all that apply. Are you a: Trustee / Board Member President / CEO Executive Vice President, Senior Vice President or Vice President Physician Other Please enter your name and email address: Name                 Email Address                 Thank you for taking our Self Assessment Survey!