Team Check-up Tool

CUSP Toolkit

Purpose of the tool: This tool helps assess unit strengths and opportunities for improving unit processes and upgrading unit safety culture.

Who should use this tool? Health care providers.

Directions: Your team should collectively complete one Team Check-up Tool every month and submit it to the project lead. The information collected will be used for individual coaching assistance and reported in aggregate with other units' Team Check-up Tool results.


Hospital Name:



 Knowledge/SkillsStrongly DisagreeDisagreeNeither Agree nor DisagreeAgreeStrongly Agree
1Five randomly selected staff members (e.g., nurses, physicians) from our unit can list at least three interventions that are part of the CUSP project.     
2Unit staff are confused about how to proceed with project activities to improve safety.     
3All staff can communicate the project's goals.     
4All team members can list the number of days between incidents on the unit.     
5There are good systems in our unit to ensure we meet the goal of <Insert a safety measure here>.     
6There is a lack of quality improvement skills on our team.     
7We perform a unit analysis for each incident using the Learning from Defects Tool.     
 Attitudes/BeliefsStrongly DisagreeDisagreeNeither Agree nor DisagreeAgreeStrongly
1We have had ownership from staff members in this unit.     
2We have had good ownership from physician staff in this unit.     
3We have had good ownership from nursing staff in this unit.     
4Staff in this unit do not believe that <incident> is an issue for this unit.     
5A junior staff member feels comfortable questioning a more senior staff member who is not following the <Insert a safety measure here>.     
6Our senior executive can state three safety concerns the staff have identified.     
 ResourcesStrongly DisagreeDisagreeNeither Agree nor DisagreeAgreeStrongly Agree
1Our team meets at least once a month.     
2There is not enough time to get our team's work done.     
3Unit leadership (managers, physicians, opinion leaders) is stable (i.e., low turnover).     
4Data collection has not been a burden.     
5Staff do not have time to collect maintenance data.     
Page last reviewed December 2012
Internet Citation: Team Check-up Tool: CUSP Toolkit. December 2012. Agency for Healthcare Research and Quality, Rockville, MD.