Implementation Guide, Appendix C: Team Performance Observation Tool

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 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.  


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.  


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.  


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.  


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.  


Overall Rating—Communication


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Page last reviewed November 2012
Page originally created November 2012
Internet Citation: Implementation Guide, Appendix C: Team Performance Observation Tool. Content last reviewed November 2012. Agency for Healthcare Research and Quality, Rockville, MD.