TeamSTEPPS® Long-Term Care Version (continued)

Appendix C: Team Performance Observation Tool

Team Performance Observation Tool

Date: _________________________
Unit: _________________________
Team: _________________________
Shift: _________________________

Rating Scale Please comment if 1 or 2	1 = Very Poor
	2 = Poor
	3 = Acceptable
	4 = Good
	5 = Excellent

 

1. Team Structure	Rating
a.  Assembles a team.
b.  Establishes a leader.
c.  Identifies team goals and vision.
d.  Assigns roles and responsibilities.
e.  Holds team members accountable.
f.  Actively shares information among team members.
Comments: Overall Rating—Team Structure

2. Leadership	Rating
a.  Utilizes resources efficiently to maximize team performance.
b.  Balances workload within the team.
c.  Delegates tasks or assignments, as appropriate.
d.  Conducts briefs, huddles, and debriefs.
e.  Empowers team members to speak freely and ask questions.
Comments: Overall Rating—Leadership

3. Situation Monitoring	Rating
a.  Includes resident/family in communication.
b.  Cross-monitors fellow team members.
c.  Applies the STEP process when monitoring the situation.
d.  Fosters communication to ensure that team members have a shared mental model.
Comments: Overall Rating—Situation Monitoring

4. Mutual Support	Rating
a.  Provides task-related support.
b.  Provides timely and constructive feedback to team members.
c.  Effectively advocates for the resident.
d. Uses the Two-Challenge rule, CUS, and DESC script to resolve conflict.
e. Collaborates with team members.
Comments: Overall Rating—Mutual Support

5. Communication	Rating
a.  Coaching feedback routinely provided to team members, when appropriate.
b.  Provides brief, clear, specific and timely information to team members.
c.  Seeks information from all available sources.
d.  Verifies information that is communicated.
e.  Uses SBAR, call-outs, check-backs, and handoff techniques to communicate effectively with team members.
Comments: Overall Rating—Communication
TEAM PERFORMANCE RATING

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