Team Performance Observation Tool

TeamSTEPPS Long-Term Care Instructor Guide

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.

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  


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 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. 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  


Overall Rating - Communication



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Page last reviewed October 2014
Page originally created October 2012
Internet Citation: Team Performance Observation Tool. Content last reviewed October 2014. Agency for Healthcare Research and Quality, Rockville, MD.