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 created a problem list, but did not prioritize said list until
prompted. Group assigned a leader and documenter, however,
Fulfills assigned roles and responsibilities from the huddle 0 1 2 3 another member often overpowered the assigned leader. 2
members only participated limitedly even after addressed by
Holds each other accountable for their roles and responsibilities 0 1 2 3 facilitator.
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 to utilize
Empowers each other to speak (including the patient/client/caregiver) 0 1 2 3 and reference resources during discussion. As previously stated, 2 members barely
participated. Would encourage students to utilize each discipline more for information
Works as a team to problem solve 0 1 2 3 required.
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 increased thought of
Includes patient/client/caregiver in communication 0 1 2 3 monitoring and next steps for the patient’s care.
Mutual Support
Actively collaborates with each other 0 1 2 3 Students did not utilize each disciplines respective expertise. For
example, if unsure of cost of cessation products, ask pharmacy. 2
Distributes work across all team members 0 1 2 3 members did not participate fully.
Communication
Provides brief, understandable, specific, useful and timely information 0 1 2 3 Students utilized provided articles for background
information.. They shared not only their knowledge, but
Seeks and communicates information from all available sources 0 1 2 3 also where it came from. Group should work to document
Facilitates integration of information as it is obtained into action plan 0 1 2 3 information discussed and utilize this information for plan
development. Students at times demonstrated closed-loop
Utilizes closed loop communication 0 1 2 3 communication, but very limited. Encouraged students to
Addresses conflict appropriately 0 1 2 3 communicate and participate, but some not responding.
ONLY RESPOND TO THE SECTION BELOW IF APPLICABLE: 0 1 2 3 Never fear addressing problems and other coworkers for
participation.
Uses communication tools (SBAR***, CUS****, call-outs, check-backs, and
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