Team Performance Observation Tool

TeamSTEPPS® Instructor Manual

Date: _________________________________

Unit/Department: _________________________________

Team: _________________________________

Shift: ________________________________

Rating Scale (circle 1) 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. Assigns or identifies team members’ roles and responsibilities  
c. Holds team members accountable  
d. Includes patients and families as part of the team  
Comments:

Overall Rating – Team Structure

 
2. Communication Rating
a. Provides brief, clear, specific and timely information to team members  
b. Seeks information from all available sources  
c. Uses check-backs to verify information that is communicated  
d. Uses SBAR, call-outs, and handoff techniques to communicate effectively with team members  
Comments:

Overall Rating – Communication

 
3. Leadership Rating
a,  Identifies team goals and vision  
b. Utilizes resources efficiently to maximize team performance  
c. Balances workload within the team  
d. Delegates tasks or assignments, as appropriate  
e. Conducts briefs, huddles, and debriefs  
f. Role models teamwork behaviors  
Comments:

Overall Rating – Leadership

 
4. Situation Monitoring Rating
a. Monitors the status of the patient  
b. Monitors fellow team members to ensure safety and prevent errors  
c. Monitors the environment for safety and availability of resources (e.g., equipment)  
d. Monitors progress toward the goal and identifies changes that could alter the plan of care  
e. Fosters communication to ensure team members have a shared mental model  
Comments:

Overall Rating – Situation Monitoring

 
5. Mutual Support Rating
a. Provides task-related support and assistance  
b. Provides timely and constructive feedback to team members  
c. Effectively advocates for patient safety using the Assertive Statement, Two-Challenge Rule, or CUS  
d. Uses the Two-Challenge Rule or DESC Script to resolve conflict  
Comments:

Overall Rating – Mutual Support

 
Team Performance Rating  

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Current as of March 2014
Internet Citation: Team Performance Observation Tool: TeamSTEPPS® Instructor Manual. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/reference/tmpot.html