Implementation Guide, Appendix D: Team Assessment Questionnaire

TeamSTEPPS® Long-Term Care Version

This guide provides an overview of the TeamSTEPPS initiative. A description of the course material, how to use it, and links to reference material on how to conduct the course, including training techniques and sample course planning tools, are provided.

 

Team Assessment Questionnaire

INSTRUCTIONS:

This assessment is a statistical measurement of your impressions of your department or unit's team behavior as it relates to resident care in your current work setting. Please answer all 55 questions so an overall score may be calculated.

Facility: _________________________
Unit:     _________________________
Date:    _________________________

SectionStrongly AgreeAgreeUndecidedDisagreeStrongly Disagree
Team Foundation
1. The team has a clear vision of what it is supposed to do.     
2. The team's activities are guided by a clear Mission Statement/Charter.     
3. The team's goals are closely aligned with the goals of the nursing home.     
4. The team has adequate skills and member resources to achieve its goals.     
5. Everyone on the team has a clear and vital role.     
6. The team has adequate meeting time, space, and resources to achieve all objectives.     
7. Team meetings are well attended by all team members.     
8. The team can measure its performance effectively.     
9. The team understands its customer requirements (internal and/or external).     
10. This team is promptly informed of changes in policy or new developments.     
11. The department or unit has clear expectations of this team.     
12. The team receives adequate training to function effectively.     
Team Functioning
13. Team meetings are run efficiently.     
14. Everyone on the team participates at an acceptable level.     
15. This team works well together.     
16. This team works well with other teams/departments in the nursing home.     
17. The goals and objectives of this team will have a positive impact on the nursing home.     
18. The team is on a continuous improvement curve.     
Team Performance
19. The team uses an effective short- and long-term strategic planning process.     
20. The team meets its (internal and/or external) customer requirements.     
21. The team is productive.     
22. Team functioning doesn't interfere with getting my own job done.     
Team Skills
23. The team members communicate well with one another.     
24. Constructive feedback is given by the team.     
25. Team members are familiar with each other's job responsibilities.     
26. The team uses effective decisionmaking processes and problem solving skills.     
27. The team monitors and progresses the plan of care.     
28. The team can change or improve the way it goes about working on its tasks.     
Team Leadership
29. My boss/supervisor promotes participation by the team in key decisions.     
30. My boss/supervisor shares responsibilities with team members.     
31. My boss/supervisor is an effective leader.     
32. I share my ideas/suggestions whether or not my boss/supervisor agrees with my input.     
33. My boss/supervisor focuses on building team’s technical and interpersonal skills.     
34. My boss/supervisor coaches and supports individual team members.     
35. My boss/supervisor promotes individual problem solving and intelligent risk taking.     
36. My boss/supervisor leads by example.     
Team Climate and Atmosphere
37. Team members trust each other.     
38. Morale on this team is high.     
39. Team members support each other.     
40. There are no feelings among team members that might pull this team apart.     
41. The team resolves conflicts soon after they occur.     
42. I feel free to express my opinions.     
43. I have an influence on team decisions.     
44. Team members can openly discuss their own problems and issues.     
45. Team members show consideration for needs and feelings of other team members.     
46. Team members receive recognition for individual performance.     
Team Identity
47. I know why I am on a team.     
48. I am pleased to be on a team.     
49. The team subscribes to a clear set of values.     
50. This team is fun to work with.     
51. No individual, group, or gender dominates team activities.     
52. The team has a positive self-image.     
53. The team recognizes the resident and his or her family as critical team members.     
54. The team is a safety net for residents.     
55. I am a member of a team in which the leader promotes teamwork.     

THANK YOU FOR FILLING OUT THIS FORM

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Page last reviewed November 2012
Internet Citation: Implementation Guide, Appendix D: Team Assessment Questionnaire: TeamSTEPPS® Long-Term Care Version. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/ltccrsmgmtappd.html