Form 1 Training participant questionnaire

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 [email protected]. Additional information about the National Implementation program can be found at http://teamstepps.ahrq.gov/.

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]

2. 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):”]

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

________________________________________________________________________________

4. 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?

________________________________________________________________________________

5. 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]

6. 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

7. 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]

8. 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.

9. 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]

10. 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]

11. 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.

12. 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

13. 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

14. 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

15. Was the measure helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

16. Was the measure accepted by staff?

1. Results were accepted

2. Results were questioned but generally accepted

3. Results were not accepted

17. 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

18. 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

19. 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

20. Was the measure helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

21. Was the measure accepted by staff?

1. Results were accepted

2. Results were questioned but generally accepted

3. Results were not accepted

22. 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

23. 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

24. 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

25. Was the measure helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

26. Was the measure accepted by staff?

1. Results were accepted

2. Results were questioned but generally accepted

3. Results were not accepted

27. 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

28. 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

29. 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

30. Was the measure helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

31. 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

32. 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

33. Was the resource helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

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

34. Have you used the following resource?

Implementation Guide

1. Yes

2. No

3. Don't Know

You have used the following resource:

Implementation Guide

35. Was the resource helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

36. Have you used the following concept?

Cross-monitoring

1. Yes

2. No

3. Don't Know

You have used the following concept:

Cross-monitoring

37. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

38. Was the concept accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

39. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

40. 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

41. Have you used the following concept?

Feedback

1. Yes

2. No

3. Don't Know

You have used the following concept:

Feedback

42. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

43. Was the concept accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

44. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

45. 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

46. Have you used the following concept?

Advocacy & Assertion

1. Yes

2. No

3. Don't Know

You have used the following concept:

Advocacy & Assertion

47. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

48. Was the concept accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

49. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

50. 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

51. Have you used the following concept?

Collaboration

1. Yes

2. No

3. Don't Know

You have used the following concept:

Collaboration

52. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

53. Was the concept accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

54. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

55. 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

56. 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

57. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

58. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

60. 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

61. 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

62. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

63. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

65. 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

66. 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

67. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

68. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

70. 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

71. 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

72. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

73. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

75. 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

76. 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}

77. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

78. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

80. 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

81. 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

82. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

83. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

85. 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

86. 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

87. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

88. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

90. 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

91. 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

92. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

93. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

95. 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

96. 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

97. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

98. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

100. 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

101. 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

102. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

103. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

105. 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

106. 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

107. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

108. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

110. 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

111. 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

112. Was the tool or strategy helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

113. Was the tool or strategy accepted by staff?

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

115. 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

116. 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

117. Was the measure helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

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

118. 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

119. Was the resource helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

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

120. 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

121. Was the resource helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources

122. Have you used the following concept?

Coaching

1. Yes

2. No

3. Don't Know

You have used the following concept:

Coaching

123. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

124. Was the concept accepted by staff?

1. Results were accepted

2. Results were questioned but generally accepted

3. Results were not accepted

125. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

126. 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

127. 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

128. 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

129. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

131. 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

132. 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

133. 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

134. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

136. 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

137. 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

138. 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

139. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

141. 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

142. 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

143. 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

144. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

146. 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

147. 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

148. 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

149. 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

150. 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

151. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

154. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

155. 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

156. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

159. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

160. 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

161. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

164. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

165. 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

166. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

1. Very much accepted

2. Somewhat accepted

3. Not at all accepted

169. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

170. 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

171. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

173. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

175. 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

176. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

178. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

180. 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

181. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

183. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

185. 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

186. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

188. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

190. 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

191. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

193. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

195. 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

196. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

198. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

200. 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

201. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

203. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

205. 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

206. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

208. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

210. 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

211. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

213. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

215. 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

216. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

218. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

220. 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

221. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

223. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

225. 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

226. 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

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

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

228. 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

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

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

230. 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

231. 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

232. 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

233. 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

234. Was the resource helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

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

235. 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

236. Was the resource helpful?

1. ^{Very helpful}

2. Somewhat helpful

3. Not at all helpful

SUSTAINMENT STAGE Concepts, Tools, Strategies, or Resources

237. 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

238. Was the concept helpful?

1. Very helpful

2. Somewhat helpful

3. Not at all helpful

239. 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

240. Is the concept still being used by staff?

1. Very often

2. Occasionally

3. Infrequently

4. Rarely

241. 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

242. 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

243. 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.

244. 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}

245. 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

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

247. 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

248. _{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

249. 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.

250. _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.

251. _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.

252. _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.

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

1