Form 1 Training participant questionnaire

Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program

ATTACHMENT C --Training Participant Questionnaire rev091415

Training participant questionnaire

OMB: 0935-0170

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Attachment C: National Implementation of TeamSTEPPS: Post-Training Survey


DRAFT


Form Approved
OMB No. 0935-0170
Exp. Date 12/31/2015

TeamSTEPPS® Master Training: Post-Training Survey




Introduction


Thank you for accessing this questionnaire. This questionnaire is intended to obtain your perceptions of the Agency for Healthcare Research and Quality’s (AHRQ)/Department of Defense’s (DoD) National Implementation of TeamSTEPPS® Program. You have been invited to complete this questionnaire because you were trained as a TeamSTEPPS Master Trainer under the National Implementation Program.


As part of this questionnaire, you are being asked to assess the usefulness of the master training program and the concepts, tools, and strategies that make up the TeamSTEPPS curriculum. You are also being asked to indicate how you have used this material, whether at your organization or while supporting other organizations.


It is important to note that this is not an evaluation of you or your progress in implementing TeamSTEPPS or your ability to share it with others. Rather, the information you provide regarding these concepts, tools, information, and resources will be used to enhance AHRQ’s repository of patient safety tools and resources, as well as future TeamSTEPPS-based initiatives. Your responses will be used to help AHRQ identify the most useful aspects of the TeamSTEPPS curriculum. Further, your responses will be used to help AHRQ identify additional support for individuals such as yourselves as you work towards improving patient safety. Your candid feedback is the only way that these enhancements can be achieved.


Please note that all of the information you provide will remain confidential, as assured under Section 934(c) of the Public Health Service Act, and that all information collected via this questionnaire will be reported at the aggregate level to ensure the confidentiality of the participants.


Should you have any questions or comments about this questionnaire or the TeamSTEPPS evaluation effort, please do not hesitate to contact David Baker, PhD, at IMPAQ International at 443-259-5134 or TeamSTEPPS_Surveys@impaqint.com. Additional information about the National Implementation program can be found at http://teamstepps.ahrq.gov/.



Shape1

Public reporting burden for this collection of information is estimated to average 20 minutes per response, the estimated time required to complete the survey. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0170, expires XX/XX/20XX), AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.




Instructions


Please carefully read each question on this questionnaire. There are five primary sections:


  • Master Trainer Characteristics

  • Post-Master Training Activities – Overall

  • Post-Master Training Activities by Concept, Tools, Strategy, or Resource

  • Facilitators and Barriers to Use of TeamSTEPPS in the Workplace

  • Outcomes of Participation in TeamSTEPPS Master Training


Note that the response scale for each question will vary from section to section. For example, some questions ask you to indicate how helpful a particular TeamSTEPPS tool or strategy has been, using a response scale ranging from ‘Not at all helpful’ to ‘Very Helpful.’ Other questions ask you to respond to a given statement using a response that indicates your level of agreement (i.e., Disagree, Neutral, or Agree). Please read each question carefully and make sure that you select the response you intend.


It is not necessary to complete the survey all at once. Select “Next” at the end of each page to save your responses. You can return to make changes to the responses you have already provided or continue to complete the survey at your convenience.


Master Trainer Characteristics


In this section, you are being asked to provide information about yourself, your organization, and your participation in the TeamSTEPPS Master Training program. Please answer candidly and note that your personal information will not be provided to any entity. All information will be reported to AHRQ on an aggregate level.


  1. Which of the following best characterizes the organization in which you currently work? [Select one]

  1. Academic health profession program

  2. Public hospital

  3. Federal government health provider

  4. Community hospital Children’s hospital Critical access hospital Outpatient clinic

  5. Quality Improvement Organization (QIO) State health department

  6. Hospital association

  7. Patient safety center/commission

  8. Risk, liability, malpractice or other Insurer

  9. Long term care facility, assisted living facility, or home health agency

  10. Regional or state-based healthcare professional association or institution

  11. Other: [Fill in the blank]


  1. In which state is your organization located? (If your organization is located outside of the US, please scroll to the bottom of the dropdown menu to identify your location.)

[STATES will be provided in a drop-down menu; the final option will read: “My organization is outside the United States (Please specify):”]


  1. What is the name of your employer facility/organization?

________________________________________________________________________________


  1. If your facility is part of a larger healthcare system, what is the name of that larger healthcare system? What is your current job title?

________________________________________________________________________________


  1. In what area did you complete your professional training? [Check all that apply]

  1. Nursing

  2. Medicine

  3. Pharmacy

  4. Public Health

  5. Health Administration

  6. Allied Health

  7. Life Science

  8. Other: [Fill in the blank]


  1. How long have you served in your current role (at your current organization)?

  1. 0-1 year

  2. 2-5 years

  3. 6-10 years

  4. 11 or more years


  1. What was the reason for your participation in TeamSTEPPS Master Training? [Check all that apply]

  1. I wanted to find out more about TeamSTEPPS.

  2. I wanted to find out more about teamwork and team training in healthcare.

  3. My organization had experienced a sentinel event or potential patient safety near miss.

  4. My organization leaders mandated our participation.

  5. We would like to introduce TeamSTEPPS in our medical or nursing education.

  6. We would like to introduce TeamSTEPPS in our in-service program.

  7. We are assisting a health provider organization improve patient safety

  8. We plan to use TeamSTEPPS as part of a research project.

  9. Other: [Fill in the blank]


  1. Where did you first learn about TeamSTEPPS Master Training being offered through the National Implementation Program?

  1. TeamSTEPPS.ahrq.gov website

  2. Another website or web search

  3. At a conference

  4. Webinars

  5. Word of Mouth

  6. AHRQ Publications

  7. A talk given by an AIR, AHRQ, or Department of Defense (DoD) representative

  8. A talk given by a health care professional not affiliated with AIR, AHRQ, or DoD

  9. A professional newsletter or publication

  10. Other: [Fill in the blank]




Post-Master Training Activities - Overall


In this section, you are being asked to provide information about your TeamSTEPPS implementation and training activities since participating in the TeamSTEPPS Master Training program.


  1. Which of the following best represents your implementation of TeamSTEPPS since participating in Master Training? [Select one]

  1. I/we have implemented TeamSTEPPS concepts, tools, or strategies in my unit/department/facility/organization.

  2. I/we have supported the implementation of TeamSTEPPS concepts, tools, or strategies in organizations that we support as a QIO.

  3. I/we have supported the implementation of TeamSTEPPS concepts, tools, or strategies in organizations that we support as a hospital or health professional association.

  4. I/we have supported the implementation of TeamSTEPPS concepts, tools, or strategies in organizations that we support as teamwork consultants.

  5. I/we have supported the implementation of TeamSTEPPS concepts, tools, or strategies in organizations that we support as insurers.

  6. Other: [Fill in the blank]


  1. Since Master Training, how have you implemented the TeamSTEPPS concepts, tools, or strategies you learned? [Check all that apply]

  1. Across our health system or organization

  2. Across our facility but not the entire health system or organization

  3. Within several units/departments but not the entire facility

  4. Within our unit/department only

  5. Other: [Fill in the blank]


  1. Since Master Training, which of the following have you accomplished? [Check all that apply]

  1. I/we have created a change team to implement TeamSTEPPS concepts, tools, or strategies in the unit/department/facility/organization.

  2. I/we have defined our teamwork problem or identified an opportunity to improve teamwork using TeamSTEPPS concepts, tools, or strategies in our unit/department/facility/organization.

  3. I/we have conducted a site assessment to define our teamwork problem or opportunity for teamwork improvement.

  4. I/we have collected data using one of AHRQ’s surveys of patient safety culture.

  5. I/we have defined the aim(s) of our TeamSTEPPS intervention.

  6. I/we have designed a formal implementation plan for our teamwork improvement intervention.

  7. I/we have created an action plan for implementation.

  8. I/we have briefed leadership and key personnel about our action plan.

  9. I/we have designed a TeamSTEPPS intervention.

  10. I/we have conducted TeamSTEPPS training for our intervention.

  11. I/we have implemented the TeamSTEPPS intervention in our unit/department/facility/organization.

  12. I/we have developed a plan for testing the effectiveness of our TeamSTEPPS intervention.

  13. I/we have measured the impact of our TeamSTEPPS intervention.

  14. I/we have developed a plan for continuous sustained improvement with our teamwork improvement intervention.

  15. I/we have developed a communication plan for our teamwork improvement intervention.








  1. Since you attended the TeamSTEPPS Master Training, approximately how many persons have you trained on any of the TeamSTEPPS concepts, tools, or strategies in your organization or other organizations?

  1. None

  2. 1-49

  3. 50-99

  4. 100-149

  5. 150-199

  6. 200-249

  7. 250-299

  8. 300-349

  9. 350-399

  10. 400-449

  11. 450-499

  12. 500 or more




  1. How many facilities are represented in the approximate number of persons you have trained since attending TeamSTEPPS Master Training?]

  1. None

  2. 1 facility

  3. 2 to 5 facilities

  4. 6 to 10 facilities

  5. 11 to 15 facilities

  6. 16 to 20 facilities

  7. 21 to 25 facilities

  8. More than 25 facilities




Post-Master Training Activities by TeamSTEPPS Concept, Tool, Strategy, or Resource


In this section, you are being asked to report on the activities in which you have engaged since your participation in the TeamSTEPPS Master Training program. Specifically, you are being asked to consider how you have used or disseminated your knowledge about TeamSTEPPS concepts, tools, or strategies since participating in the program.


Specifically, you will answer some or all of the following questions:


  • Have you implemented or used each concept, tool, strategy, or resource?

  • Was each concept, tool, strategy, or resource helpful?

  • Have you implemented the concept, tool, or strategy?

  • Was each concept, tool, or strategy accepted by staff?

  • Is each concept, tool, or strategy still being used by staff?

  • What are the primary areas in which you have implemented or used each concept, tool, strategy, or resource?


ASSESSMENT STAGE: Concepts, Tools, Strategies, or Resources


  1. Have you used the following measure?


AHRQ Surveys of Patient Safety Culture

  1. Yes

  2. No

  3. Don't Know


You have used the following measure:


AHRQ Surveys of Patient Safety Culture


  1. Was the measure helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you have implemented or used this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]


ASSESSMENT STAGE: Concepts, Tools, Strategies, or Resources


  1. Have you used the following measure?


TeamSTEPPS Teamwork Attitudes Questionnaire

  1. Yes

  2. No

  3. Don't Know


You have used the following measure:

TeamSTEPPS Teamwork Attitudes Questionnaire

  1. Was the measure helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you have implemented or used this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]


ASSESSMENT STAGE: Concepts, Tools, Strategies, or Resources


  1. Have you used the following measure?


Team Performance Observation Tool

  1. Yes

  2. No

  3. Don't Know


You have used the following measure:


Team Performance Observation Tool


  1. Was the measure helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you have implemented or used this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]


ASSESSMENT STAGE: Concepts, Tools, Strategies, or Resources


  1. Have you used the following measure?


TeamSTEPPS Readiness Assessment

  1. Yes

  2. No

  3. Don't Know


You have used the following measure:

TeamSTEPPS Readiness Assessment

  1. Was the measure helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted



ASSESSMENT STAGE: Concepts, Tools, Strategies, or Resources


  1. Have you used the following resource?


TeamSTEPPS Guide to Action

  1. Yes

  2. No

  3. Don't Know


You have used the following resource:

TeamSTEPPS Guide to Action

  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following resource?


Implementation Guide

  1. Yes

  2. No

  3. Don't Know


You have used the following resource:


Implementation Guide


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following concept?


Cross-monitoring

  1. Yes

  2. No

  3. Don't Know


You have used the following concept:


Cross-monitoring


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following concept?


Feedback

  1. Yes

  2. No

  3. Don't Know


You have used the following concept:


Feedback


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following concept?


Advocacy & Assertion

  1. Yes

  2. No

  3. Don't Know


You have used the following concept:


Advocacy & Assertion


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. ntensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following concept?


Collaboration

  1. Yes

  2. No

  3. Don't Know


You have used the following concept:


Collaboration


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Briefs

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Briefs


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Huddles

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Huddles


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Debriefs

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Debriefs


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


STEP Assessment

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


STEP Assessment


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Two-Challenge Rule

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:

Two-Challenge Rule


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


CUS

  1. Yes

  2. No

  3. Don't Know



You have used the following tool or strategy:


CUS


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


DESC Script

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


DESC Script


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


SBAR

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


SBAR


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Call-out

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Call-out


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Check-back

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Check-back


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


Handoff

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


Handoff


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following tool or strategy?


I Pass the Baton

  1. Yes

  2. No

  3. Don't Know


You have used the following tool or strategy:


I Pass the Baton


  1. Was the tool or strategy helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following measure?


TeamSTEPPS Learning Benchmarks

  1. Yes

  2. No

  3. Don't Know


You have used the following measure:

TeamSTEPPS Learning Benchmarks


  1. Was the measure helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following resource?


TeamSTEPPS Vignettes & Scenarios

  1. Yes

  2. No

  3. Don't Know


You have used the following resource:

TeamSTEPPS Vignettes & Scenarios


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following resource?


TeamSTEPPS for Rapid Response Systems (RRS) Module

  1. Yes

  2. No

  3. Don't Know


You have used the following resource:


TeamSTEPPS for Rapid Response Systems (RRS) Module


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following concept?


Coaching

  1. Yes

  2. No

  3. Don't Know


You have used the following concept:


Coaching


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you have implemented or used this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you used the following resource?


Change Management Guide

  1. Yes

  2. No

  3. Don't Know


You have used the following resource:


Change Management Guide


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



Post-Master Training Activities by TeamSTEPPS Concept, Tool, Strategy, or Resource


In this section, you are being asked to report on the activities in which you have engaged since your participation in the TeamSTEPPS Master Training program. Specifically, you are being asked to consider how you have used or disseminated your knowledge about TeamSTEPPS concepts, tools, or strategies since participating in the program.


Specifically, you will answer some or all of the following questions.


  • Have you supported others in the implementation or use of each concept, tool, strategy, or resource?

  • Was each concept, tool, strategy, or resource helpful while supporting others in their implementation?

  • Was each concept, tool, or strategy accepted by staff while supporting others in their implementation?

  • Is each concept, tool, or strategy still being used by staff?

  • What are the primary areas in which you supported others in their implementation or use of each concept, tool, strategy, or resource?


ASSESSMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following measure?


AHRQ Surveys of Patient Safety Culture

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following measure:


AHRQ Surveys of Patient Safety Culture


  1. Was the measure helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you supported others in their implementation or use of this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



ASSESSMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following measure?


TeamSTEPPS Teamwork Attitudes Questionnaire

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following measure:


TeamSTEPPS Teamwork Attitudes Questionnaire


  1. Was the measure helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you supported others in their implementation or use of this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



ASSESSMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following measure?


Team Performance Observation Tool

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following measure:


Team Performance Observation Tool


  1. Was the measure helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the measure still being used by staff?

  1. Every 24 months

  2. Every 18 months

  3. Every 12 months

  4. The survey will NOT be administered again


  1. What are the primary areas in which you supported others in their implementation or use of this measure? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



ASSESSMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following measure?


TeamSTEPPS Readiness Assessment

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following measure:


TeamSTEPPS Readiness Assessment


  1. Was the measure helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the measure accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted



ASSESSMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following resource?


TeamSTEPPS Guide to Action

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following resource:


TeamSTEPPS Guide to Action


  1. Was the resource helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following resource?


Implementation Guide

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following resource:


Implementation Guide


  1. Was the resource helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following concept?


Cross-monitoring

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following concept:


Cross-monitoring


  1. Was the concept helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff while supporting others in their implementation?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following concept?


Feedback

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following concept:


Feedback


  1. Was the concept helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff while supporting others in their implementation?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following concept?


Advocacy & Assertion

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following concept:


Advocacy & Assertion


  1. Was the concept helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff while supporting others in their implementation?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following concept?


Collaboration

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following concept:


Collaboration


  1. Was the concept helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff while supporting others in their implementation?

  1. Very much accepted

  2. Somewhat accepted

  3. Not at all accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Briefs

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Briefs


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Huddles

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Huddles


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Debriefs

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Debriefs


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


STEP Assessment

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


STEP Assessment


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Two-Challenge Rule

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Two-Challenge Rule


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


CUS

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


CUS


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]




PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


DESC Script

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


DESC Script


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


SBAR

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


SBAR


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Call-out

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Call-out


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Check-back

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Check-back


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


Handoff

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


Handoff


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following tool or strategy?


I Pass the Baton

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following tool or strategy:


I Pass the Baton


  1. Was the tool or strategy helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the tool or strategy accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the tool or strategy still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this tool or strategy? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following measure?


TeamSTEPPS Learning Benchmarks

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following measure:


TeamSTEPPS Learning Benchmarks


  1. Was the measure helpful while supporting others in their implementation?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following resource?


TeamSTEPPS Vignettes & Scenarios

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following resource:


TeamSTEPPS Vignettes & Scenarios


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



PLANNING, TRAINING, & IMPLEMENTATION STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following resource?


TeamSTEPPS for Rapid Response Systems (RRS) Module

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following resource:

TeamSTEPPS for Rapid Response Systems (RRS) Module


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful



SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following concept?


Coaching

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following concept:


Coaching


  1. Was the concept helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful


  1. Was the concept accepted by staff while supporting others in their implementation?

  1. Results were accepted

  2. Results were questioned but generally accepted

  3. Results were not accepted


  1. Is the concept still being used by staff?

  1. Very often

  2. Occasionally

  3. Infrequently

  4. Rarely


  1. What are the primary areas in which you supported others in their implementation or use of this concept? [Check all that apply]

  1. Many different facilities or units

  2. Medicine (nonsurgical)

  3. Surgery

  4. Obstetrics

  5. Pediatrics

  6. Emergency Dept

  7. Intensive Care Unit

  8. Psychiatry/Mental Health

  9. Rehabilitation

  10. Pharmacy

  11. Laboratory

  12. Radiology

  13. Anesthesiology

  14. Other: [Fill in the blank]



SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources


  1. Have you supported others in the use of the following resource?


Change Management Guide

  1. Yes

  2. No

  3. Don't Know


You have supported others in the use of the following resource:


Change Management Guide


  1. Was the resource helpful?

  1. Very helpful

  2. Somewhat helpful

  3. Not at all helpful





Facilitators and Barriers to Use of TeamSTEPPS Concepts, Tools, or Strategies in the Workplace


In this section, you are being asked to identify any factors (organizational or otherwise) you have encountered that facilitated the use of TeamSTEPPS concepts, tools, or strategies. Similarly, you are asked to identify any barriers you have encountered when trying to use or support others in the use of TeamSTEPPS concepts, tools, or strategies. These barriers can be organizational or individual; in either case they impede the use of TeamSTEPPS concepts, tools, or strategies.



  1. Which of the following factors have helped you implement the TeamSTEPPS concepts, tools, or strategies in your organization or in organizations that you have supported? [Check all that apply]


  1. Ample time made available to support the use of concepts

  2. Ample resources made available to support the use of concepts

  3. Consistent information sharing among people within the organization to support the use of concepts

  4. Upper management support for using concepts

  5. Staff willingness to use concepts

  6. Unease with current practice leading to perceived need to use concepts

  7. Effective communication of information resulting in better understanding regarding the use of

  8. concepts

  9. Ample coordination and follow-up with co-workers to ensure the proper use of concepts

  10. Organizational priorities that draw attention to the use of concepts

  11. Work sharing or shifting of staff responsibilities to support the implementation of concepts

  12. Consistency in team membership leading to sustained momentum in implementation or use of concepts

  13. Commitment from the Employed Medical Staff resulting in adoption of concepts

  14. Commitment from the Non-Employed Medical Staff resulting in adoption of concepts




  1. How important were the facilitators you selected to the success of your TeamSTEPPS implementation

Facilitators

Not at all important

Somewhat important

Very important

Ample time made available to support the use of concepts




Ample resources made available to support the use of concepts




Consistent information sharing among people within the organization to support the use of concepts




Upper management support for using concepts




Staff willingness to use concepts




Unease with current practice leading to perceived need to use concepts




Effective communication of information resulting in better understanding regarding the use of concepts




Ample coordination and follow-up with co-workers to ensure the proper use of concepts




Organizational priorities that draw attention to the use of concepts




Work sharing or shifting of staff responsibilities to support the implementation of concepts




Consistency in team membership leading to sustained momentum in implementation or use of concepts




Commitment from the Employed Medical Staff resulting in adoption of concepts




Commitment from the Non-Employed Medical Staff resulting in adoption of concepts






  1. What other factors have helped you implement TeamSTEPPS concepts, tools, or strategies since attending training? Please list all major facilitators that you have experienced.









  1. Which of the following barriers have you encountered when implementing the TeamSTEPPS concepts, tools, or strategies in your organization or in organizations that you have supported? [Check all that apply]


  1. Lack of time made available to support the use of concepts

  2. Lack of resources made available to support the use of concepts

  3. Lack of information sharing between people within the organization to support the use of concepts

  4. Upper management resistance to the use of concepts

  5. Staff resistance to using the concepts

  6. Comfort with the status quo leading to perceptions that the use of concepts is not needed

  7. Conflicting information resulting in confusion about the use of concepts

  8. Lack of coordination and follow-up with co-workers to ensure the proper use of concepts

  9. Distractions or different organizational priorities that draw attention away from the use of concepts

  10. Reported staff fatigue or work overload leading to inability or resistance to learning about and using concepts

  11. Inconsistency in team membership leading to maintain momentum in implementation or use of concepts

  12. Hierarchical structure leading to resistance to learning about and using concepts

  13. Staff conflict resulting in the inability to implement the concepts

  14. Lack of Commitment/Engagement from the Employed Medical Staff resulting in resistance to the adoption of concepts

  15. Lack of Commitment/Engagement from the Non-Employed Medical Staff resulting in resistance to the adoption of concepts






  1. How important was overcoming the barriers you selected to the success of your TeamSTEPPS implementation?


Barriers

Not at all important

Somewhat important

Very important

Lack of time made available to support the use of concepts




Lack of resources made available to support the use of concepts




Lack of information sharing between people within the organization to support the use of concepts




Upper management resistance to the use of concepts




Staff resistance to using the concepts




Comfort with the status quo leading to perceptions that the use of concepts is not needed




Conflicting information resulting in confusion about the use of concepts




Lack of coordination and follow-up with co-workers to ensure the proper use of concepts




Distractions or different organizational priorities that draw attention away from the use of concepts




Reported staff fatigue or work overload leading to inability or resistance to learning about and using concepts




Inconsistency in team membership leading to maintain momentum in implementation or use of concepts




Hierarchical structure leading to resistance to learning about and using concepts




Staff conflict resulting in the inability to implement the concepts




Lack of Commitment/Engagement from the Employed Medical Staff resulting in resistance to the adoption of concepts




Lack of Commitment/Engagement from the Non-Employed




Medical Staff resulting in resistance to the adoption of concepts






  1. Please identify any other barriers to the implementation of TeamSTEPPS concepts, tools, or strategies you have encountered since attending training.






Outcomes of Master Training Participation


In this section, you are being asked to assess what patient safety changes have occurred in your organization or organizations you support as a result of your participation in TeamSTEPPS Master Training and your post-Master Training activities. These outcomes of your participation in TeamSTEPPS Master Training and your post-Master Training activities can range from increased awareness to changes in processes or policies. Consider all potential outcomes of your participation and post-training activities.


  1. As a result of participating in TeamSTEPPS Master Training and your post-Master training activities, how have the following aspects changed at your organization?


TEAM STRUCTURE


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

Patients and their families are considered part of the team.





Staff have increased awareness of their roles and responsibilities during treatment of patients.





Patients are valued members of the patient care team.





Staff understand their roles and responsibilities.






COMMUNICATION


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

Feedback between staff is delivered in a way that promotes positive interactions and future change.





Staff advocate for patients, even when their opinion conflicts with that of a senior member of the unit.





When staff have a concern about a patient, they challenge others until they are sure the concern has been heard.





Staff resolve their conflicts, even when the conflicts have become personal.





Information regarding patient care is explained to patients and their families in lay terms.





Staff rely on nonverbal communication to communicate their message.





Staff relay relevant information in a timely manner.





When communicating with patients, staff allow enough time for questions.





Staff use common terminology when communicating with each other.





Staff call out critical information during emergent situations.





Staff verbally verify information that they receive from one another.





Staff follow a standardized method of sharing information when handing off patients.





Staff seek information from all available sources.






LEADING TEAMS


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

Staff share a clear mental model of how the patient will be treated for his/her condition.





Staff are engaging in debriefs after patient disposition.





Staff are engaging in huddles during treatment to ensure a clear picture of treatment actions.





Staff are engaging in briefs prior to treating a patient.





Staff are held accountable for their actions.





Staff within my unit share information that enables timely decision making by the direct patient care team.





My unit makes efficient use of resources (e.g., staff, supplies, equipment, information).





My unit expects all staff, even those who are not part of the direct care team, to contribute to patient safety.





Supervisors/managers/team leaders consider staff input when making decisions about patient care.





Supervisors/managers/team leaders provide opportunities to discuss the unit’s performance after an event.





Supervisors/managers/team leaders take time to meet with staff to develop a plan for patient care.





Supervisors/managers/team leaders do a better job at ensuring that adequate resources (e.g., staff, supplies, equipment, information) are available.






SITUATION MONITORING


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

Staff exchange relevant information as it becomes available.





Staff continuously scan the environment for important information.





Staff share information regarding potential complications (e.g., patient changes, bed availability).





Staff consider each other's physical and emotional status (i.e., fatigue, general health, stress, hunger).





Staff meet to reevaluate patient care goals when aspects of the situation have changed.





Staff re-route and/or delay work tasks to prevent task overload.





Staff caution each other about potentially dangerous situations.






MUTUAL SUPPORT


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

Staff are more assertive when advocating for the patient.





Staff can more easily resolve conflicts about the treatment of patients.





Staff feel more comfortable providing task assistance to their team members even if not requested.





Staff are more willing to assist others when assistance is requested.





Staff assist fellow staff during high workload.





Staff request assistance from fellow staff when they feel overwhelmed.








  1. As a result of participating in the TeamSTEPPS Master Training program and your post-Master Training activities, how have the following aspects changed at your organization?

As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed that in my organization...

Disagree

Neutral

Agree

Does Not Apply

It is now easier to address the Joint Commission’s patient safety requirements.





Patient satisfaction has improved.





Staff satisfaction has improved.





There has been a reduction in the number of medication errors.





It has been easier to meet our score card measures related to quality.





Patient safety is viewed as a top priority of management.





Our handoffs across units have improved.





Staff will freely speak up if they see something that may negatively affect patient care.





Staff now question the decisions or actions of those with more authority when they are concerned that the decisions or actions may negatively affect patient care.





We handle a greater patient volume within the unit.





Handoffs between shifts within units have improved.





Patients report a high level of teamwork between doctors and nurses.





We make better use of the resources within the unit (e.g., beds, supplies, staff).





Patient flow within the unit has improved.





The number of patient complications occurring in the unit has dropped.





The number of hospital acquired infections in the unit has dropped.





The turnover rate within the unit has declined.







  1. Since participating in the TeamSTEPPS Master Training program and your post-Master Training activities, how have the following aspects changed at the organizations you support?


As a result of participating in TeamSTEPPS Master Training and my post-Master Training patient safety activities, I have noticed…

Disagree

Neutral

Agree

Does Not Apply

Healthcare providers at organizations that I support are actively doing things to improve patient safety.





Positive changes in the organizational culture at organizations I support.





The organizations I support evaluate the effectiveness and sustainability of the interventions/changes.





Staff at the organizations I support have reported increased awareness about the role of teamwork in reducing the risk of hospital acquired infections.










Staff at the organizations I support have attributed a reduced risk associated with medical errors to the implementation of TeamSTEPPS concepts, tools, or strategies.





Patient satisfaction has improved at the organizations I support.





Staff satisfaction has improved at the organizations I support.





Patient safety is viewed as a top priority of management at the organizations I support.





Handoffs across units have improved at the organizations I support.





Staff at the organizations I support will freely speak up if they see something that may negatively affect patient care.





Staff at the organizations I support will question the decisions or actions of those with more authority when they are concerned that the decisions or actions may negatively affect patient care.





Resources (e.g., beds, supplies, staff) are used more efficiently by the organizations I support.





The number of patient complications occurring at the organizations I support has dropped.





The number of hospital acquired infections in the organizations I support has dropped.





The turnover rate within the organizations I support has declined.







  1. What other outcomes can you attribute to your participation in TeamSTEPPS Master Training and your post-Master Training activities?









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