Clinical Supervision On a Shoe String:doing more with less
Margaret A. BramwellSocial Work ManagerSVH Sydney
12 June 2014
Footnote to go hereDay/Month/Year Page 2
Footnote to go here
Cairns and FNQ
Regional SW covering travelling from Innisfail to TI to Normanton
Supervising staff in Cairns/ Atherton/ Mareeba
Day/Month/Year Page 3
Clinical Supervision: Our lens
We all come to Supervision as an instrument with experience
Context: professional background
Social Work : commitment to Clinical supervision
Positive and negative experiences
Respect for the principles of Adult Education
Educator / Pupil
Footnote to go here
Social Work : Clinical Supervision
Alfred Kadushin 2002:
“The relationship is the communication bridge between people.”
Three Supervision components: Education Management
Support.
Day/Month/Year Page 6
Clinical Supervision: Why do it?
Studies show that effective clinical supervision leads to improved well-being, confidence and self-awareness, reduces emotional strain and burnout, and individuals experience greater professional growth.
For the workforce it increases staff morale, job satisfaction, staff proficiency and retention of a more highly skilled workforce.
Studies also show that the positive impact that clinical supervision has is most likely a result of the training that supervisors receive, the quality of supervision they provide and the culture and managerial attitudes within the organisation. (White & Winstanley 2010).
Page 7
Footnote to go here
Clinical Supervision: Assets
Things that cost nothing but are critical components of Supervision:
You Engagement Dedicated time for Supervision - Protect it ! Mutual Aid Respect Agreed contract Reflective practice Active Listening Confidentiality/ Escalation Education Support Professional behaviour
Day/Month/Year Page 8
Clinical Supervision:
Representative sample of work- are they safe today?
Use of critical reflection / feedback
Process recording- what they said, responses
Observe- One way screens
Face time/ Skype – city, rural, remote, international supervision
Finding a supervisor when resources are limited Draw upon other agencies – Community Health/ GP’s/ Clinical
Psychologists in Private Practice/ other specialists
Form an interprofessional group
12/6/2014 Page 9
STAR Project 2013 SVH
Recent Student SVH 2013 survey
Students were asked the 3 most important attributes of a clinical supervisor
ApproachableSupportive
Good Communicator
12/6/2014 Page 10
Students were asked which factors they thought affect clinical supervisors being
able to perform their role well
Lack of timeLack of appropriate trainingLack of interest in the role
Please note: these results reflect the most significant rate of responses and not all results are shown in these tables.
STAR Program 2013 SVH Sydney
Supervisees value: 2013 SVH
Page 11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Not important at all
Not very important
Not sure
Somewhat important
Very important
Students were asked how important it is that clinical supervisors performed the following activities
Supervision:Peer group
Peer group supervision usually refers to reciprocal arrangements in which peers work together for mutual benefit where developmental feedback is emphasised and self directed learning and evaluation is encouraged (Benshoff, J.M. 1992).
Increased access / frequency of supervision
Reciprocal learning through the sharing of experiences
Increased skills and responsibility for self assessment and
Decreased dependency on expert supervisors
Footnote to go hereDay/Month/Year Page 13
Supervision:Peer supervision
7 factors for Effective Peer Group Supervision:
EqualitySupportive CultureStructure: ‘checking in’ and agenda set / supervisee
and supervisor roles Placeing a high value on turning upSuper + VisionSelf Directed – No Post mortems
( A. McNicoll, NZ Mentoring Centre- 2008)
Footnote to go here
Supervision: Peer groups
Diverse modalities of presentation will be used; including case discussion, theoretical discussion, case- based learning, role plays and TED talks.
Non-hierarchical with a rotating facilitator
Focus on capacity building and being fluid rather than rigid in format
Ensure there is collegial listening and it is a safe environment
Day/Month/Year Page 14
Footnote to go here
Interprofessional Supervision
Definition of IPE:
“Occasions when two or more professionals learn from, with and about each other to improve collaboration and the quality of care”
(Thistlethwaite, 2012; Reeves et al 2012)
Day/Month/Year Page 15
Footnote to go here
Clinical Supervision: Interprofessional
World Health Organisation (2010) show that interprofessional teaching and supervision can prepare health professionals for team-based care or interprofessional collaborative practice (IPCP).
The benefits: increased staff motivation, well-being and retention decreases in staff turnover increased patient satisfaction increased patient safety increases in appropriate use of specialist clinical resources reductions in patient mortality and critical incidents increases in access to and coordination of health services enhances the learners understanding of other professionals roles and
responsibilities fosters mutual respect promotes teamwork and collaboration
Day/Month/Year Page 16
Marie Heydon Project Officer CETI 2011 Page 17
Get Ready!A Course for Interprofessional Work-Place Readinessin the Health Service14 to 18 November 2011
Delivered by St Vincents & Mater Health Sydney in collaboration with our University partners:
University of New South Wales – St Vincent’s Clinical School The University of Sydney Australian Catholic University
University of Tasmania, School of Nursing and Midwifery
Get Ready
Day/Month/Year Marie Heydon Project Officer CETI 2011 Page 18
Results Excellent attendance and participation from 52 Nursing, Medical and Allied Health students
across the week of the 14th – 18th November 2011
Robust quantitative and qualitative data very strongly support the effectiveness of this one week program in addressing the core interprofessional competencies.
95% of all combined repeated measure items across four tools were statistically significant demonstrating an objective indicator of positive program impact
Qualitative feedback strongly supported these findings. Sample student comments from across professions include: ‘absolutely enjoyed the program, ability to work in a multidisciplinary team has improved a lot’; ‘concept great, very needed....simulation and Human Factors DVD excellent’; ‘terrific, informative and enjoyable, thanks’;
92% students endorsed this program for other pre-graduates with either unqualified support or a range of constructive suggestions
Students actively contributed suggestions for program refinement and enhancement and these comments have been incorporated into revised program recommendations
Footnote to go here
Interprofessional Supervision
Studies suggest that in the interprofessional context, supervision from educators whose profession differs from that of the students can be a beneficial and rewarding experience for students and that a supportive, clinician-focused, content-oriented supervision offered by knowledgeable and skilled clinical experts has been perceived as beneficial, regardless of the supervisor’s profession (Townend 2005, Chipchase 2012).
Draw upon the strengths of your interprofessional colleagues
Diversification of staff supervision
Collaboration, communication and consultation
Day/Month/Year Page 19
Footnote to go here
Clinical Supervision: STAR Program
The pilot program at SVH Sydney focused on delivering the project objectives of developing an interprofessional education program to increase clinical supervisor competence and confidence.
Day/Month/Year Page 20
Footnote to go here
STAR Program covered diverse topics including:
balancing the clinical workload and the supervision role, balancing education, support and managerial functions in supervision, setting supervision contracts/agreements & learning goals, building relationships and identifying learning styles, understanding adult teaching skills, developing effective communication skills, reflective practice & advanced reasoning skills, managing conflict and challenging conversations, providing constructive feedback to over and under performers
Day/Month/Year Page 21
Footnote to go here
STAR : training new supervisors
STAR program: HWA Pilot Program to expand clinical supervision capacity and competency. Supervision, Training and Readiness (STAR) Program Provided an interprofessional developmental mentoring program for new
clinical supervisors Aims - to develop and enhance the quantity and quality of clinical supervisors
across the interprofessional domains - Confident and competent clinical supervision - Collaboration in the supervision of clinical practice activities - Enhance capacities and skill of experienced supervisors through
implementation of education modules such as e-learning, role playing, simulation and face to face sessions and peer mentoring groups,
- Evaluated
We designed an innovative program that can be utilised across other health
care facilities for a consistent and collaborative approach in enhancing the quality and capacity of interdisciplinary clinical supervision.
Day/Month/Year Page 22
Footnote to go here
Evaluation:
A five level ‘Likert Scale’ was used for the first four questions of the session evaluation to quantitatively measure the relevance of the content and whether appropriate teaching methods were utilised.
The scale was set as outlined below:
1.Strongly disagree
2.Disagree
3.Neither agree nor disagree
4.Agree
5.Strongly agree
Day/Month/Year Page 23
Footnote to go here
STAR : evaluation
Day/Month/Year Page 24
Clinica
l Sup
ervis
ion &
Ove
rsigh
t
Adult
Lear
ning
Princip
les &
Sty
les
Debrie
fing
& Con
stru
ctive
Fee
dbac
k
Reflec
tion
IP P
eer M
ento
ring
Group
s0
1
2
3
4
5
Wednesday
Saturday
Q4. The content of the training program was relevant to my needs and provided knowledge and skills that can be utilised in my role as a clinical supervisor
Footnote to go here
Evaluation:
Day/Month/Year Page 25
Clinica
l Sup
ervis
ion &
Ove
rsigh
t
Adult
Lear
ning
Princip
les &
Sty
les
Debrie
fing
& Con
stru
ctive
Fee
dbac
k
Reflec
tion
IP P
eer M
ento
ring
Group
s0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Wednesday
Saturday
Q2. I was actively involved in the learning process which stimulated my interest
Footnote to go here
STAR:
The opportunity for interprofessional supervision was ‘appreciated’ and the several participants think the STAR program will assist them to be a more structured supervisor, be more approachable, flexible and effective as a supervisor to provide the best learning experiences for their supervisees.
The majority of participants found the interactive activities most beneficial. The videoed scenarios, case studies, role plays and group discussions were considered the most effective and constructive. Many commented that being able to share experiences and hear from others was enjoyable and promoted IP collaboration
Day/Month/Year Page 26
Footnote to go here
Questions????
Thank you
Day/Month/Year Page 27