Table of Contents

TeamSTEPPS 

Framework and Competencies

Key Principles

Team Structure

• Multi-Team System For 

Patient Care

Leadership

• Effective Team Leaders

• Team Events

• Brief Checklist

Debrief Checklist

Situation Monitoring

Situation Monitoring Process

• Cross Monitoring

• STEP

• I’M SAFE Checklist

Mutual Support

• Task Assistance

• Feedback

Advocacy and Assertion

• Two-Challenge Rule

• CUS 

• DESC Script

• Collaboration

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Table of Contents

Communication

• SBAR

• Call-Out

• Check-Back

• Handoff

“I PASS THE BATON”

Team Performance Observation Tool

Barriers, Tools & Strategies, 

and Outcomes

Contact Information

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TeamSTEPPSTM

TeamSTEPPS is comprised of four teachable-learnable 

skills: Leadership, Situation Monitoring, Mutual Support, 

and Communication; the core of the TeamSTEPPS 

framework. The red arrows depict a two-way dynamic 

interplay between the four skills and the team-related 

outcomes. Interaction between the outcomes and skills 

is the basis of a team striving to deliver safe, quality care. 

Encircling the four skills is the patient care team which 

not only represents the patient and direct caregivers, but 

those who play a supportive role within the healthcare 

delivery system.

...TeamSTEPPS is an evidence-based framework to 

optimize team performance across the healthcare 

delivery system

Team Competency Outcomes

Knowledge

Shared Mental Model

Attitudes

Mutual Trust

Team Orientation

Performance

Adaptability

Accuracy

Productivity

Efficiency

Safety

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Key Principles

Team Structure

Delineates fundamentals such as team 

size, membership, leadership, composition, 

identification and distribution

Leadership

Ability to coordinate the activities of team 

members by ensuring team actions are 

understood, changes in information are 

shared, and that team members have the 

necessary resources

Situation Monitoring

Process of actively scanning and assessing 

situational elements to gain information, 

understanding, or maintain awareness to 

support functioning of the team

Mutual Support

Ability to anticipate and support other team 

members’ needs through accurate knowledge 

about their responsibilities and workload

Communication

Process by which information is clearly and 

accurately exchanged among team members
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Team Structure

The ratio of we’s to I’s is 

the best indicator of the 

development of a team...

 —Lewis B. Ergen
Team Structure

Multi-Team System

 For Patient Care

ADMINISTRATION 

COORDINATING 

TEAM

ANCILLARY

& SUPPORT

SERVICES

CORE TEAM 

CONTINGENCY 

TEAMS 

PATIENT 

MTS 
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Leadership

The art of getting someone 

else to do something you 

want done because he wants 

to do it...

—Dwight D. Eisenhower
Effective Team Leaders

• Organize the team

• Articulate clear goals

• Make decisions through 

collective input of members

• Empower members to 

speak up and challenge, 

when appropriate

• Actively promote and 

facilitate good teamwork

• Skillful at conflict resolution

Leadership
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Team Events

Planning

• Brief - Short session prior to 

start to discuss team formation; 

assign essential roles; establish 

expectations and climate; 

anticipate outcomes and likely 

contingencies

Problem Solving

• Huddle - Ad hoc planning to 

reestablish situation awareness; 

reinforcing plans already in place; 

and assessing the need to adjust 

the plan

Process Improvement

• Debrief - Informal information 

exchange session designed to 

improve team performance and 

effectiveness; after action review 

Leadership
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Brief Checklist

During the brief, the team should 

address the following questions:

Who is on the team?

All members understand and 

agree upon goals?

Roles and responsibilities are 

understood?

What is our plan of care?

Staff and provider’s availability 

throughout the shift? 

Workload among team 

members? 

Availability of resources? 

Leadership
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Debrief Checklist

The team should address the 

following questions during a debrief:

Communication clear?

Roles and responsibilities 

understood?

Situation awareness 

maintained?

Workload distribution equitable?

Task assistance requested or 

offered?

Were errors made or avoided?

Availability of resources? 

What went well, what should 

change, what should improve?

Leadership
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Situation

Monitoring

Attention to detail is one of 

the most important details...

 —Author Unknown
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Situation Monitoring

Situation monitoring is the process of 

continually scanning and assessing 

what’s going on around you to maintain 

situation awareness.

Situation awareness is “knowing what is 

going on around you.” 

With a shared mental model, all team 

members are “on the same page.” 

Situation Monitoring Process
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Situation Monitoring

Cross Monitoring

An error reduction strategy 

that involves:

• Monitoring actions of other 

team members

• Providing a safety net within 

the team

• Ensuring mistakes or 

oversights are caught 

quickly and easily

• “Watching each other’s 

back”
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Situation Monitoring

STEP

A tool for monitoring situations 

in the delivery of health care

Components of Situation Monitoring:
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Situation Monitoring

STEP

	Assess Status of Patient

	Patient History

	Vital Signs 

	Medications 

	Physical Exam

	Plan of Care

	Psychosocial 

	Assess Level of Team Members’

	Fatigue

	Workload

	Task Performance

	Skill 

	Stress 

	Assess Environment

	Facility Information 

	Administrative Information 

	Human Resources 

	Triage Acuity

	Equipment 

	Assess Progress Towards Goal

	Status of Team’s Patient(s)?

	Established Goals of Team?

	Tasks/Actions of Team?

	Plan Still Appropriate? 
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Situation Monitoring

I’M SAFE Checklist

	I = Illness

	M = Medication

	S = Stress

	A = Alcohol and Drugs

	F = Fatigue

	E = Eating and Elimination

An individual team member’s 

responsibility...
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Mutual

Support

A chain is only as strong as 

its weakest link...

 —Author Unknown
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Mutual Support

Task Assistance

A form of mutual support:

• Team members protect 

each other from work 

overload situations

• Effective teams place all 

offers and requests for 

assistance in the context of 

patient safety

• Team members foster a 

climate where it is expected 

that assistance will be 

actively sought and offered

In support of patient safety,

it’s expected!
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Mutual Support

Feedback

Information provided for the purpose 

of improving team performance

	Feedback should be:

	Timely – given soon after the 

target behavior has occurred

	Respectful – focus on behaviors, 

not personal attributes

	Specific – be specific about what 

behaviors need correcting

	Directed towards improvement 

– provide directions for future 

improvement

	Considerate – consider a team 

member’s feelings and deliver 

negative information with 

fairness and respect 
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Mutual Support

Advocacy and Assertion

Advocate for the patient

Invoked when team members’ 

viewpoints don’t coincide with 

that of the decision maker

Assert a corrective action in a 

firm and respectful manner

Make an opening

State the concern

Offer a solution

Obtain an agreement

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Two-Challenge Rule

When an initial assertion is ignored:

• It is your responsibility to assertively 

voice concern at least two times to 

ensure it has been heard

• The team member being challenged 

must acknowledge 

• If the outcome is still not acceptable: 

o Take a stronger course of action

o Utilize supervisor or chain 

of command

Empowers all team members to “stop 

the line” if they sense or discover an 

essential safety breach

Mutual Support
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CUS 

“Stop the Line”

Mutual Support
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DESC Script

A constructive approach for 

managing and resolving conflict

 D – Describe the specific 

situation or behavior; 

provide concrete data

 E – Express how the situation 

makes you feel/what your 

concerns are

 S – Suggest other alternatives 

and seek agreement

 C – Consequences should be 

stated in terms of impact 

on established team goals; 

strive for consensus

Mutual Support
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Collaboration

Achieves a mutually satisfying 

solution resulting in the best 

outcome

Win-Win-Win for Patient Care 

Team (includes the patient, 

team members, and team)

Commitment to a common 

mission

Meet goals without compromising 

relationships

“True collaboration is a 

process, not an event”

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Mutual Support
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Communication

Communication is the 

response you get from the 

message you sent 

regardless of its intent

 —Author Unknown
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SBAR

A technique for communicating critical 

information that requires immediate 

attention and action concerning a 

patient’s condition

Situation – What is going on with the patient?

 “I am calling about Mrs. Joseph in room 

251. Chief complaint is shortness of breath 

of new onset.”

Background – What is the clinical background 

or context? 

“Patient is a 62 year old female post-op 

day one from abdominal surgery. No prior 

history of cardiac or lung disease.”

Assessment – What do I think the problem is?

“Breath sounds are decreased on the 

right side with acknowledgement of pain. 

Would like to rule-out pneumothorax.”

Recommendation and Request – What 

would I do to correct it?

“I feel strongly the patient should be 

assessed now. Are you available to 

come in?” 

Communication
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Call-Out

Strategy used to communicate 

important or critical information

• Informs all team members 

simultaneously during emergent 

situations

• Helps team members anticipate 

next steps

• Important to direct responsibility 

to a specific individual 

responsible for carrying out the 

task

Example during an incoming trauma:

Leader: “Airway status?”

Resident: “Airway clear”

Leader: “Breath sounds?”

Resident: “Breath sounds 

decreased on right”

Leader: “Blood pressure?”

Nurse: “BP is 96/62”

Communication
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Check-Back

Process of employing closedloop communication to ensure 

that information conveyed by 

the sender is understood by the 

receiver as intended

The steps include the following:

1. Sender initiates the message

2. Receiver accepts the message and 

provides feedback

3. Sender double-checks to ensure that 

the message was received

Example:

Doctor: “Give 25 mg Benadryl IV push”

Nurse: “25 mg Benadryl IV push”

Doctor: “That’s correct” 

Communication
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Handoff

The transfer of information (along 

with authority and responsibility) 

during transitions in care across the 

continuum; to include an opportunity 

to ask questions, clarify, and confirm. 

Examples of transitions in care 

include shift changes, physicians 

transferring complete responsibility, 

and patient transfers.

Communication
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Handoff

Strategy designed to enhance information 

exchange during transitions in care

 “I PASS THE BATON”

I Introduction Introduce yourself and your role/

job (include patient)

P Patient Name, identifiers, age, sex, 

location

A Assessment Present chief complaint, vital 

signs, symptoms, and diagnosis

S Situation

Current status/circumstances, 

including code status, level of 

(un)certainty, recent changes, 

and response to treatment 

S SAFETY 

Concerns

Critical lab values/reports, socioeconomic factors, allergies, and 

alerts (falls, isolation, etc.)

THE

B Background

Co-morbidities, previous 

episodes, current medications, 

and family history

A Actions What actions were taken or are 

required? Provide brief rationale

T Timing

Level of urgency and explicit 

timing and prioritization of 

actions

O Ownership Who is responsible (person/team) 

including patient/family?

N Next

What will happen next? 

Anticipated changes? 

What is the plan? 

Are there contingency plans?

Communication
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Team Performance Observation Tool

Team Structure

Assembles team

Establishes leader

Identifies team goals and vision

Assigns roles and responsibilities

Holds team accountable

Actively shares information

Leadership

Utilizes resources to maximize performance

Balances workload within the team

Delegates tasks or assignments, as appropriate

Conducts briefs, huddles, and debriefs

Empowers team to speak freely and ask questions

Situation Monitoring

Includes patient/family in communication

Cross monitors team members

Applies the STEP process

Fosters communication to ensure a shared 

 mental model

Mutual Support

Provides task-related support

Provides timely and constructive feedback

Effectively advocates for the patient

Uses the Two-Challenge rule, CUS, and DESC 

 script to resolve conflict

Collaborates with team

Communication

Coaching feedback routinely provided to team 

 members when appropriate

Provides brief, clear, specific, and timely information

Seeks information from all available sources

Verifies information that is communicated

Uses SBAR, call-outs, check-backs, and 

 handoff techniques
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BARRIERS

• Inconsistency in Team 

Membership

• Lack of time• Lack of Information 

Sharing 

• Hierarchy• Defensiveness• Conventional Thinking• Complacency• Varying Communication 

Styles

• Conflict• Lack of Coordination 

and Follow-Up with Co-Workers

• Distractions• Fatigue• Workload• Misinterpretation of Cues• Lack of Role Clarity

TOOLS & STRATEGIES

Brief

Huddle

Debrief

STEP

Cross Monitoring

Feedback

Advocacy and Assertion

Two-Challenge Rule

CUS

DESC Script

Collaboration

SBAR

Call-Out

Check-Back

Handoff

OUTCOMES

• Shared Mental Model• Adaptability• Team Orientation• Mutual Trust• Team Performance• Patient Safety!!
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To learn more about TeamSTEPPS, refer 

to the Agency for Healthcare Research 

and Quality (AHRQ) website:

http://www.ahrq.gov/teamstepps

and the Department of Defense Patient 

Safety Program website:

http://dodpatientsafety.usuhs.mil/

teamstepps

Developed for the Department of Defense 

Patient Safety Program in collaboration with the 

Agency for Healthcare Research and Quality 

TeamSTEPPSTM Pocket Guide – 06.1

Contact Information
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Version 06.1

AHRQ Pub. No. 06-0020-2 ISBN 1-58763-191-1

Revised March 2008