TeamBirth Huddle Observation Form

Submit your hospital's TeamBirth Huddle Observation Forms.

Fields marked * are required.

Select Hospital *

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Date *

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Did your hospital have any births in the reporting month? *

If your hospital did not have any births, you still must submit one form indicating "No" in order to receive credit for monthly submisison.

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Observer Name (optional)

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Observer Role *

Choose the role that most closely aligns with your role, even if it isn't exact.

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What prompted the huddle? *

Select all that apply.

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Other reason for huddle

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Who wrote on the shared planning board? *

Select all that apply.

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Was it clearly state this was a TeamBirth huddle? *

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Was each person introduced by name and role at the beginning? *

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Were the name and roles written on the shared planning board? *

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Was the patient invited to share preferences/concerns about the current plan? *

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Were the patient's preferences/concerns about the plan written on the board? *

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Was the patient offered options & choices about the current plan and did decisions incorporate or address their preferences or concerns? *

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Was the plan for me/mom written and up-to-date on the shared planning board? *

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Was the plan for baby written and up-to-date on the shared planning board? *

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Was the plan for labor progress written and up-to-date on the shared planning board? *

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Were admissions discussion guides used at any time to support this huddle? *

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Were labor support guides used at any time to support this huddle? *

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Did the team discuss expectations for when the next huddle may occur? *

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Were the expectations written on the shared planning board? *

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How confident did you feel leading or participating in this huddle? *

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What types of support or learning would be most helpful to increase confidence with TeamBirth huddles?

If Other was selected, enter here:

What specific actions or huddle behaviors worked well during this huddle?

What made this huddle harder than ideal, or what limited its effectiveness?

What is one small change that would make the biggest difference next time?

Please attest to personally observing or being a part of a TeamBirth huddle by selecting your role in the huddle: *

This field is required.

Optional: receive a copy of your responses by email.

Email me a copy of my submission