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 required prompting to prioritize
list. Group greatly collaborated and assigned topics to each person
Fulfills assigned roles and responsibilities from the huddle 0 1 2 3 to cover during patient interaction.
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. Went extra mile by
researching OTC alternatives with evidence for diet and diabetes.. They shared their sources
Empowers each other to speak (including the patient/client/caregiver) 0 1 2 3 of information well with each other.
Works as a team to problem solve 0 1 2 3
Situation Monitoring
1 Included patient in discussion well by asking them their base knowledge from their provided resources.
Cross monitors members and applies STEP** process 0 2 3 Allowed patient to guide discussion and facilitated with adding information and clarifying points. During
Includes patient/client/caregiver in communication 0 1 2 3 wrap-up, expressed need to address follow-up and monitoring to set patients goals and expectations.

Mutual Support
Actively collaborates with each other 0 1 2 3 Students utilized each others expertise to address patient issues.
Assigned topics to cover to each person and add support to topics
Distributes work across all team members 0 1 2 3 if patient asked questions relevant to their expertise.
Communication
Provides brief, understandable, specific, useful and timely information 0 1 2 3 Students utilized provided articles for background
information. Students educated patient on what resources
Seeks and communicates information from all available sources 0 1 2 3 they used and provided them with easy to find places to
Facilitates integration of information as it is obtained into action plan 0 1 2 3 find reputable information such as .gov or .edu sites and
CDC, FDA, or hospital/medical group websites. Group
Utilizes closed loop communication 0 1 2 3 should create summary of information covered and next
Addresses conflict appropriately 0 1 2 3 steps to patient at end of discussion. Encouraged students
ONLY RESPOND TO THE SECTION BELOW IF APPLICABLE: 0 1 2 3 to utilize closed-loop communication as a way to make the
patient feel heard and assure truly understanding the
Uses communication tools (SBAR***, CUS****, call-outs, check-backs, and
patients concerns and 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