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Perspectives about andModels for Supervision in the

Health Professions 

Violet H. Barkauskas, PhD, RN, MPH, FN

!he "niversit# of Michi$an

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Focus of the Presentation 

!he conte%t of health care

Fra&e'orks for supervision in health

care

(%a&ples of fra&e'ork application

(vidence of effectiveness

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)onte%t of Health )are * +estern

Hierarchical s#ste& of oversi$ht)linical supervision is a &aor

e&phasis because of-

)oncern for patients)urrent re*e&phases on patient safet#

Rei&burse&ent certification re$ulations

)oncerns about liti$ation

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)o&&on (%a&ples

!rainin$ education / students in allprofessional discipline

Professional develop&ent re0uire&ents

1versi$ht of assistant2ancillar#personnel)o&&on 3al&ost ubi0uitous4 in &ost

settin$s, especiall# for nursin$(%a&ples / nursin$ assistants in hospitals

nursin$ ho&es, ho&e health aides,co&&unit# health 'orkers

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Proctor5s Model of Supervision 367894

Nor&ative / d&inistration :ualit# ssurance  Mana$e proects (nsure patient safet# ssess assure 0ualit# ;&prove practice

Restorative / Support ssistance 'ith )opin$  ;dentif# solutions to proble&s in practice lleviate stress

For&ative / (ducation Professional Develop&ent  Skills kno'led$e

 

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pplications of the Model

Nor&ative 3&ana$e&ent, safet#, assurance4 Meetin$s 1bservation of care For&al evaluation !elephone consultation

Docu&entation in hard electronic &edia Patient records ctivit# lo$s

Restorative 3support assistance 'ith copin$4

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Heron5s Model of Supervision 367874

uthoritative Supervision ;nterventionsPrescriptive / direct behavior

;nfor&ative / $ive infor&ation2instruct

)onfrontin$ / challen$e

Facilitative Supervision ;nterventions)athartic / release tension2stron$ e&otion

)atal#tic / encoura$e self*e%plorationSupportive / validate2confir&

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Po'ell5s Model of Supervision 3677=4

)o&ponents d&inistrative

(valuative

)linical

Supportive 

)onceptuali>ation of supervisor as a servant leader 'ho ;s self*a'are

1perates 'ith focus ener$#

;s proficient in &an# aspects of the ob

Makes the or$ani>ations &ission vision clear b# standin$ aheadof the follo'ers 'hile standin$ behind their actions

Shares po'er 

Values people b# carin$ for the&

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ssu&ptions of Po'ell5s Model of

)linical Supervision 3Po'ell, 677=4

People have the abilit# to brin$ about chan$e in theirlives 'ith the assistance of a $uide.

People do not al'a#s kno' 'hat is best for the& asthe# &a# be blinded b# their resistance to denialof the issues.

!he ke# to $ro'th is to blend insi$ht behavioralchan$e in the ri$ht a&ounts at the appropriate ti&e.

)han$e is constant inevitable. ;n supervision, as in therap#, the $uide concentrates

on 'hat is chan$eable. ;t is not necessar# to kno' about the cause or

function of a &anifest proble& to resolve it. !here are &an# correct 'a#s to vie' the 'orld.

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Structure of Supervision

;ndividual / 6 to 6 6 supervisor 6 supervisee

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Supervision Venues 

Routine interactions on the ob;nfor&all#;n scheduled &eetin$s

;ndirectl# / e.$., b# talkin$ to patients!hrou$h re&ote co&&unication!elephone

)o&puter +ritten docu&entation, e.$., lo$s, records,

reports

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)urrent Supervision Debates

:ualifications of the supervisors Fro& the sa&e discipline different discipline peer collea$ue

(%pertise )ontent of care Processes of develop&ent

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(vidence * Supervision (ffectiveness3Cil&inster oll#, A, p. 8==4

Supervision has a positive effect on patientoutco&e lack of supervision is har&ful topatients.

Supervision has &ore effect 'hen the

trainee is less e%perienced.Self*supervision is not effective.!he 0ualit# of the relationship bet'een

supervisor supervisee is probabl# the

sin$le &ost i&portant factor for effectivesupervision.Behavioral chan$es can occur 0uickl# /

chan$es in thinkin$ attitude take lon$er.

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!ips

)o&bine supervision 'ith focusedfeedback

)ontinuit#

Reflection b# both participants

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)haracteristics of (ffective

Supervisors

(&pathetic Supportive Fle%ible ;nterested in supervision

!rack supervisees effectivel# Eink theor# 'ith practice (n$a$e in oint proble&*solvin$ ;nterpretative Respectful Focused Practical Cno'led$eable 

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)haracteristics of ;neffective

Supervisors 

Ri$id Eo' e&path# Eo' support Failure to consistentl# track supervisee concerns

Failure to teach or instruct ;ndirect intolerant )losed Eack respect for differences

Non*colle$ial Eackin$ in praise encoura$e&ent Se%ist (&phasi>e evaluation, 'eaknesses, deficiencies

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Reco&&ended )ontent for

Supervisor !rainin$

Supervision fra&e'orks

ssess&ent of learnin$ needs

!eachin$ the adult learner )ounselin$

Provision of feedback

;ssues of po'er social stratification!ranscultural relationships

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References

Heron, . 367874. Six category intervention analysis.

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