Interprofessional Collaborative Behaviors Assessment*

Please respond to the following statements with the frequency in which each behavior occurs for the team as a whole, using the scale provided.
Please provide additional notes/comments for each, based on what you observe during the patient encounter.
0=NEVER 1=SOMETIMES 2=OFTEN 3=N/A
Behavior Never Observed Behavior Observed 1-2 Behavior Observed 3 or Behavior Does not Apply
times more times to this Situation

NOTES
Team Structure
Meets goals identified in the huddle (team goals) 0 1 2 3 Team should work to create problem list and rank them in
order of priority without prompting. Did well once
Fulfills assigned roles and responsibilities from the huddle 0 1 2 3 prompted. Team assigned roles of documenter, leader,
Holds each other accountable for their roles and responsibilities 0 1 2 3 and discussed discipline.
Leadership
Utilizes available resources 0 1 2 3 Team did well reviewing all information provided prior to session, including the
supplemental articles. They also clearly researched needed areas and continued
Empowers each other to speak (including the patient/client/caregiver) 0 1 2 3 to utilize and reference resources during discussion. Each member allowed
Works as a team to problem solve 0 1 2 3 discussion and encouraged each other to share information.
Situation Monitoring
Cross monitors members and applies STEP** process 0 1 2 3 Students should continue to try and develop goals to address and steps to achieve them.
Had to prompt students to prioritize problems. Also would encourage students to consider
Includes patient/client/caregiver in communication 0 1 2 3 all aspects of the patient situation such as cost and transportation.
Mutual Support
Actively collaborates with each other 0 1 2 3 Students looked for each disciplines expertise and asked relevant
questions to gain knowledge to apply in decisions. They assigned
Distributes work across all team members 0 1 2 3 clear roles and followed them to support each other.
Communication
Provides brief, understandable, specific, useful and timely information 0 1 2 3 Students utilized provided articles and their respective
disciplines resources to gain relevant information. They
Seeks and communicates information from all available sources 0 1 2 3 shared not only their knowledge, but also where it came
Facilitates integration of information as it is obtained into action plan 0 1 2 3 from. Group should work to document information
discussed and utilize this information for plan
Utilizes closed loop communication 0 1 2 3 development. Students at times demonstrated closed-loop
Addresses conflict appropriately 0 1 2 3 communication, but I believe this could be improved and
ONLY RESPOND TO THE SECTION BELOW IF APPLICABLE: 0 1 2 3 increased. Often times key points during sharing of
knowledge was missed, and repeating what was discussed
Uses communication tools (SBAR***, CUS****, call-outs, check-backs, and
may improve understanding of points.
handoff techniques; please indicate which tools were used in your notes).
*Adapted from University of Washington (2011)
**STEP=Status of the patient; Team members; Environment; Progress towards goals, is a tool for monitoring situations in the delivery of health care.
***SBAR=Situation, Background, Assessment, Recommendations
****CUS=Concerned, Uncomfortable, Safety Issue