Appendix B Team Stepps Strategies


TeamSTEPPS® is an evidence-based framework used to optimize team performance across the health care system. It is a mnemonic standing for Team Strategies and Tools to Enhance Performance and Patient Safety. The Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD) developed the TeamSTEPPS® framework as a national initiative to improve patient safety by improving teamwork skills and communication.[1]

Learn More

View this video about the TeamSTEPPS® framework[2]:

TeamSTEPPS® is based on establishing team structure and four teamwork skills: communication, leadership, situation monitoring, and mutual support. The components of this model are described in the following sections.

Team Structure

A nursing leader establishes team structure by assigning or identifying team members’ roles and responsibilities, holding team members accountable, and including clients and families as part of the team.


Communication is the first skill of the TeamSTEPPS® framework. As previously discussed, it is defined as a “structured process by which information is clearly and accurately exchanged among team members.” All team members should use these skills to ensure accurate interprofessional communication:

  • Provide brief, clear, specific, and timely information to other team members.
  • Seek information from all available sources.
  • Use ISBARR and handoff techniques to communicate effectively with team members.
  • Use closed-loop communication to verify information is communicated, understood, and completed.
  • Document appropriately to facilitate continuity of care across interprofessional team members.


Leadership is the second skill of the TeamSTEPPS® framework. As previously discussed, it is defined as the “ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources.” An example of a nursing team leader in an inpatient setting is the charge nurse.

Effective team leaders demonstrate the following responsibilities[3]:

  • Organize the team.
  • Identify and articulate clear goals (i.e., share the plan).
  • Assign tasks and responsibilities.
  • Monitor and modify the plan and communicate changes.
  • Review the team’s performance and provide feedback when needed.
  • Manage and allocate resources.
  • Facilitate information sharing.
  • Encourage team members to assist one another.
  • Facilitate conflict resolution in a learning environment.
  • Model effective teamwork.

Three major leadership tasks include sharing a plan, monitoring and modifying the plan according to situations that occur, and reviewing team performance. Tools to perform these tasks are discussed in the following subsections.

Sharing the Plan

Nursing team leaders identify and articulate clear goals to the team at the start of the shift during inpatient care using a “brief.” The brief is a short session to share a plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and contingencies. See a Brief Checklist in the following box with questions based on TeamSTEPPS®.[4]

Brief Checklist

During the brief, the team should address the following questions:[5]

  • Who is on the team?
  • Do all members understand and agree upon goals?
  • Are roles and responsibilities understood?
  • What is our plan of care?
  • What are staff and provider’s availability throughout the shift?
  • How is workload shared among team members?
  • Who are the sickest clients on the unit?
  • Which clients have a high fall risk or require 1:1?
  • Do any clients have behavioral issues requiring consistent approaches by the team?
  • What resources are available?

Monitoring and Modifying the Plan

Throughout the shift, it is often necessary for the nurse leader to modify the initial plan as patient situations change on the unit. A huddle is a brief meeting before and/or during a shift to establish situational awareness, reinforce plans already in place, and adjust the teamwork plan as needed. Read more about situational awareness in the “Situation Monitoring” subsection below.

Reviewing the Team’s Performance

When a significant or emergent event occurs during a shift, such as a “code,” it is important to later review the team’s performance and reflect on lessons learned by holding a “debrief” session. A debrief is an informal information exchange session designed to improve team performance and effectiveness through reinforcement of positive behaviors and reflection on lessons learned.[6] See the following box for a Debrief Checklist.

Debrief Checklist[7]

The team should address the following questions during a debrief:

  • Was communication clear?
  • Were roles and responsibilities understood?
  • Was situation awareness maintained?
  • Was workload distribution equitable?
  • Was task assistance requested or offered?
  • Were errors made or avoided?
  • Were resources available?
  • What went well?
  • What should be improved?

Situation Monitoring

Situation monitoring is the third skill of the TeamSTEPPS® framework and is defined as the “process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning.” Situation monitoring refers to the process of continually scanning and assessing the situation to gain and maintain an understanding of what is going on around you. Situation awareness refers to a team member knowing what is going on around them. The team leader creates a shared mental model to ensure all team members have situation awareness and know what is going on as situations evolve. The STEP tool is used by team leaders to assist with situation monitoring.[8]


The STEP tool is a situation monitoring tool used to know what is going on with you, your patients, your team, and your environment. STEP stands for Status of the patients, Team members, Environment, and Progress toward goal. See an illustration of STEP in Figure 7.7.[9] The components of the STEP tool are described in the following box.[10]


  1. AHRQ. (2019, June). TeamSTEPPS 2.0.
  2. AHRQ Patient Safety. (2015, April 29). TeamSTEPPS overview. [Video]. YouTube. All rights reserved.
  3. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  4. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  5. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  6. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  7. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  8. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.
  9. “stepfig1.jpg” by unknown author is licensed under Public Domain. Access for free at
  10. AHRQ. (2020, January). Pocket guide: TeamSTEPPS.


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Leading Change in Health Systems: Strategies for RN-BSN Students Copyright © 2023 by Kathy Andresen DNP, MPH, RN, CNE is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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