tmpot.htm

Research

TeamSTEPPS® Instructor Guide

Team Performance Observation Tool

Date:  _________________________________

Unit:  _________________________________

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 StructureRating
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. LeadershipRating
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 MonitoringRating
a. Includes patient/family in communication 
b. Cross monitors fellow team members 
c. Applies the STEP process when monitoring the situation 
d. Fosters communication to ensure team members have a shared mental model 
Comments:

Overall Rating - Situation Monitoring

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

Overall Rating - Mutual Support

 
5. CommunicationRating
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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Current as of December 2012
Internet Citation: tmpot.htm. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/reference/tmpot.html