Feedback Form: Coaching Workshop
TeamSTEPPS® Long-Term Care Version, Module 9
The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.
Instructions:
While observing the scripted coaching role play, use this form to document the demonstrated competencies of the designated coach. The coach works through the designated issue with the team member, the team member acts out the particular scenario, and the observer watches the interaction and notes on the coaching observation form which competencies the coach exhibits and does not exhibit.
Coaching Criteria | Demonstrated Competency |
Comments/Suggestions | |
---|---|---|---|
Yes | No | ||
Communication | |||
Communication Instructions | |||
Providing Feedback | |||
Listening for Understanding | |||
Performance Improvement | |||
Setting Performance Goals | |||
Rewarding Improvement | |||
Dealing With Failure | |||
Assessing Strength and Weaknesses | |||
Relationships | |||
Building Rapport and Trust | |||
Motivating Others | |||
Working With Personal Issues | |||
Confronting Difficult Situations | |||
Execution | |||
Responding to Requests | |||
Following Through |
Page last reviewed November 2012
Page originally created November 2012
Page originally created November 2012
Internet Citation: Feedback Form: Coaching Workshop. Content last reviewed November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/longtermcare/module9/ltccoachfdbk.html