Team Performance Observation Tool
TeamSTEPPS® Instructor Manual
Date: _________________________________
Unit/Department: _________________________________
Team: _________________________________
Shift: ________________________________
- Rating Scale (circle 1) 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. Assigns or identifies team members’ roles and responsibilities | |
c. Holds team members accountable | |
d. Includes patients and families as part of the team | |
Comments:
Overall Rating – Team Structure |
|
2. Communication | Rating |
a. Provides brief, clear, specific and timely information to team members | |
b. Seeks information from all available sources | |
c. Uses check-backs to verify information that is communicated | |
d. Uses SBAR, call-outs, and handoff techniques to communicate effectively with team members | |
Comments:
Overall Rating – Communication |
|
3. Leadership | Rating |
a, Identifies team goals and vision | |
b. Utilizes resources efficiently to maximize team performance | |
c. Balances workload within the team | |
d. Delegates tasks or assignments, as appropriate | |
e. Conducts briefs, huddles, and debriefs | |
f. Role models teamwork behaviors | |
Comments:
Overall Rating – Leadership |
|
4. Situation Monitoring | Rating |
a. Monitors the status of the patient | |
b. Monitors fellow team members to ensure safety and prevent errors | |
c. Monitors the environment for safety and availability of resources (e.g., equipment) | |
d. Monitors progress toward the goal and identifies changes that could alter the plan of care | |
e. Fosters communication to ensure team members have a shared mental model | |
Comments:
Overall Rating – Situation Monitoring |
|
5. Mutual Support | Rating |
a. Provides task-related support and assistance | |
b. Provides timely and constructive feedback to team members | |
c. Effectively advocates for patient safety using the Assertive Statement, Two-Challenge Rule, or CUS | |
d. Uses the Two-Challenge Rule or DESC Script to resolve conflict | |
Comments:
Overall Rating – Mutual Support |
|
Team Performance Rating |