Performance Assessment Communication and Teamwork Tools Set (PACT)

The Performance Assessment of Communication and Teamwork (PACT) is a 5-instrument tool set developed at the University of Washington to assess teamwork behaviors aligned with the TeamSTEPPS framework—team structure, leadership, situation monitoring, mutual support, and communication. It includes both self-report measures (often used pre/post) and observational tools completed by facilitators, and is commonly used in simulation-based team training to provide formative feedback to learners and help faculty or program leaders evaluate training effectiveness and identify areas needing reinforcement. 

PACT – Novice Observer Form  

The PACT Novice Observer Form captures students’ perceptions of their team’s overall performance across the five TeamSTEPPS teamwork domains (Performance Assessment of Communication and Teamwork Novice Observer Form, 2011). Learners complete the ratings about the team as a whole, ranking the team on each of the five domains after they have participated in or observed a teamwork activity or simulation. 

Question Scale: Five choices anchored from Poor → Average → Excellent. 

Questions: Ratings are organized by 5 domains 

• Team structure  
• Identifies goals, assigns roles and responsibilities, holds members accountable 
• Leadership  
• Utilizes resources, delegates tasks and balances workload, conducts briefs, huddles, and debriefs, empowers members to speak freely 
• Situation monitoring  
• Includes patient/family in communication, cross monitors members and applies the step process, fosters communication 
• Mutual support  
• Advocates for the patient, resolves conflict using two challenge rule, CUS and DESC script, works collaboratively  
• Communication 
• Provides brief, clear, specific and timely information, seeks and communicates information from all available sources uses SBAR, call‐outs, check‐backs and handoff techniques 

PACT – Expert Observer Form (facilitator/experienced rater) 

The PACT Expert Observer Form evaluates teamwork behaviors using specific behavioral markers and overall domain quality across the five TeamSTEPPS domains (Performance Assessment of Communication and Teamwork Expert Observer Form, 2011). Facilitators or trained raters watch a team scenario, score 13 behavioral marker items, and then assign global quality ratings for each of the five domains. 

Part 1 – Frequency and Quality of Behavioral Markers 

Facilitators rate the team’s performance on a Frequency and Quality scale 

Frequency scale:  

• Present (P) -The behaviors is present.  
• Absent (A)-The behavior is absent.  
• Not Applicable (NA)-There was no opportunity for the team to demonstrate such behavior.  

Quality scale:  

• Poor (P)-The team performed poorly.  
• Need Improvement (NI)-The team performed okay but there is still space for growth.  
• Satisfactory (S)-The team performance met expectation but the quality can be better.  
• Excellent (E)-The team performed well.  
• Not Applicable (NA)-The team did not demonstrate such behavior or there was not enough information to judge the quality of the behavior. 

Behavioral Markers  

Team Structure    

• Team members recognize a leader.  
• Team members refer to established protocols and checklists for the procedure/intervention.  

Leadership    

• The team leader conducts briefs, huddles, and/or debriefs.  
• The team leader empowers team members to speak freely and ask questions.  

Situation Monitoring    

• The team applies the STEP process when monitoring the situation. STEP-Status of the Patient, Team Members, Environment, Progress Towards Goal  
• The patient/family is included in communication.  

Mutual Support    

• Team members ask each other for assistance prior to or during periods of task overload.  
• Team members use the Two-Challenge rule or CUS to resolve conflict.  

Communication    

• Team members verbalize their activities aloud when they are actively involved with the patient.  
• Team members repeat back or paraphrase instructions and clarifications to indicate that they heard them correctly.  
• Team member A hands off the patient’s case to team member B, and team member B assumes responsibility for the patient.  
• The team demonstrates efficient communication skills, including patient Situation, Background, Assessment, and Recommendation (SBAR).  
• Team members demonstrate closed-loop communication such as check-backs. 

Part 2 – Global Quality  

Global Quality scale for domains:  

• NIM: Need Improvement in Most areas  
• NIS: Need Improvement in Some areas  
• S: Satisfactory  
• E: Excellent  
• NEI: Not Enough Information to Answer  

Domains used for ranking 

• Team structure  
• Identifies goals, assigns roles and responsibilities, holds members accountable   
• Leadership  
• Utilizes resources, delegates tasks and balances workload, conducts briefs, huddles, and debriefs, empowers members to speak freely   
• Situation monitoring  
• Includes patient/family in communication, cross monitors members and applies the step process, fosters communication   
• Mutual support  
• Advocates for the patient, resolves conflict using two challenge rule, CUS, and DESC script, works collaboratively   
• Communication  
• Provides brief, clear, specific and timely information, seeks and communicates information from all available sources uses SBAR, call-outs, check-backs and handoff techniques 

Sources:

• Choi JJ, Schreurs S, Leung PB, Penner JC, Torre D, Hickner A, Piazza A, Durning SJ, Teunissen PW, Maggio LA. Variability and gaps in teamwork assessment tools for health care teams in health professions education: A scoping review. Med Educ. 2025 Sep;59(9):910-923. doi: 10.1111/medu.15620. Epub 2025 Feb 17. PMID: 39962734; PMCID: PMC12355641. 
• National Center for Interprofessional Practice and Education. (2016, October 24). Performance assessment communication and teamwork tools set (PACT). NexusIPE. https://nexusipe.org/advancing/assessment-evaluation/performance-assessment-communication-and-teamwork-tools-set-pact 
• Shrader S, Farland MZ, Danielson J, Sicat B, Umland EM. A Systematic Review of Assessment Tools Measuring Interprofessional Education Outcomes Relevant to Pharmacy Education. Am J Pharm Educ. 2017 Aug;81(6):119. doi: 10.5688/ajpe816119. PMID: 28970620; PMCID: PMC5607729.