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 and prioritized them accordingly.
Group assigned a leader and documenter. Clearly defined their
Fulfills assigned roles and responsibilities from the huddle 0 1 2 3 disciplines, but did not utilize each other for respective
knowledge/expertise.
Holds each other accountable for their roles and responsibilities 0 1 2 3
Leadership
Utilizes available resources 0 1 2 3 Team did well reviewing all information provided prior to session. Encouraged students to
dive deeper into the diet pill by looking into each individual ingredient. They utilized and
Empowers each other to speak (including the patient/client/caregiver) 0 1 2 3 shared their respective reputable resources during discussion. Would encourage students to
utilize each others expertise and direct questions relevant to them accordingly.
Works as a team to problem solve 0 1 2 3
Situation Monitoring
Cross monitors members and applies STEP** process 0 1 2 3 Patient was disappointed they were not provided next steps or clear plan moving forward
During wrap-up, expressed need to address follow-up and monitoring to set patients goals
Includes patient/client/caregiver in communication 0 1 2 3 and expectations.
Mutual Support
Actively collaborates with each other 0 1 2 3 Students did not utilize each disciplines respective expertise.
Encouraged student to continue increased collaboration activities
Distributes work across all team members 0 1 2 3 to develop trust in other professionals.
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. Also clearly expressed what
Facilitates integration of information as it is obtained into action plan 0 1 2 3 reputable resources would be and how to find them to the
patient. Group should create summary of information
Utilizes closed loop communication 0 1 2 3 covered and next steps to patient at end of discussion.
Addresses conflict appropriately 0 1 2 3 Encouraged students to utilize closed-loop communication
ONLY RESPOND TO THE SECTION BELOW IF APPLICABLE: 0 1 2 3 as a way to make the patient feel heard and assure truly
understanding the patients concerns and points.
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