Implementation Guide, Appendix C: Team Performance Observation Tool
TeamSTEPPS® Long-Term Care Version
Team Performance Observation Tool
Date: _________________________
Unit: _________________________
Team: _________________________
Shift: _________________________
Rating Scale 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. 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. Leadership | Rating |
---|---|
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 Monitoring | Rating |
---|---|
a. Includes resident/family in communication. | |
b. Cross-monitors fellow team members. | |
c. Applies the STEP process when monitoring the situation. | |
d. Fosters communication to ensure that team members have a shared mental model. | |
Comments: Overall Rating—Situation Monitoring |
4. Mutual Support | Rating |
---|---|
a. Provides task-related support. | |
b. Provides timely and constructive feedback to team members. | |
c. Effectively advocates for the resident. | |
d. Uses the Two-Challenge rule, CUS, and DESC script to resolve conflict. | |
e. Collaborates with team members. | |
Comments: Overall Rating—Mutual Support |
5. Communication | Rating |
---|---|
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 |
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TEAM PERFORMANCE RATING |