TeamSTEPPS Fundamentals Course: Module 9

Coaching Feedback Form

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.

TeamSTEPPS® Fundamentals Course: Module 9

Coaching Workshop

Coaching Feedback Form

Instructions:

While observing the scripted coaching role play, use this form to document the demonstrated competencies of the designated coach. The coach works through the designated issue with the team member, the team member acts out the particular scenario, and the observer watches the interaction and notes on the coaching observation form which competencies the coach exhibits and does not exhibit.

Coaching CriteriaDemonstrated
Competency		Comments/Suggestions
YesNo
Communication
Communication Instructions   
Providing Feedback   
Listening for Understanding   
Performance Improvement
Setting Performance Goals   
Rewarding Improvement   
Dealing With Failure   
Assessing Strength and Weaknesses   
Relationships
Building Rapport and Trust   
Motivating Others   
Working With Personal Issues   
Confronting Difficult Situations   
Execution
Responding To Requests   
Following Through   

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Current as of November 2008
Internet Citation: TeamSTEPPS Fundamentals Course: Module 9: Coaching Feedback Form. November 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module9/coachfdbkform.html