Team Performance Observation Tool
TeamSTEPPS Long-Term Care Instructor Guide
Date: _________________________________
Unit: _________________________________
Team: _________________________________
Shift: ________________________________
- Rating Scale (circle one) 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 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. Routinely provides coaching feedback 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 |