Perspectives about and Models for Supervision in the Health Professions

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Perspectives about and Models for Supervision in
the Health Professions

• Violet H. Barkauskas, PhD, RN, MPH, FAAN
• The University of Michigan

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Focus of the Presentation

• The context of health care
• Frameworks for supervision in health care
• Examples of framework application
• Evidence of effectiveness

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Context of Health Care - Western

• Hierarchical system of oversight
• Clinical supervision is a major emphasis because
  of
• Concern for patients
• Current re-emphases on patient safety
• Reimbursement certification regulations
• Concerns about litigation

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Common Examples

• Training education students in all
  professional discipline
• Professional development requirements
• Oversight of assistant/ancillary personnel
• Common (almost ubiquitous) in most settings,
  especially for nursing
• Examples nursing assistants in hospitals
  nursing homes, home health aides, community
  health workers

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Proctors Model of Supervision (1987)

• Normative Administration Quality Assurance
• Manage projects
• Ensure patient safety
• Assess assure quality
• Improve practice
• Restorative Support Assistance with Coping
• Identify solutions to problems in practice
• Alleviate stress
• Formative Education Professional Development
• Skills knowledge

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Applications of the Model

• Normative (management, safety, assurance)
• Meetings
• Observation of care
• Formal evaluation
• Telephone consultation
• Documentation in hard electronic media
• Patient records
• Activity logs
• Restorative (support assistance with coping)
• Group supervision
• Case conferences
• Identification of solutions to problems in
  practice
• Formative (education professional development)
• Continuing education

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Herons Model of Supervision (1989)

• Authoritative Supervision Interventions
• Prescriptive direct behavior
• Informative give information/instruct
• Confronting challenge
• Facilitative Supervision Interventions
• Cathartic release tension/strong emotion
• Catalytic encourage self-exploration
• Supportive validate/confirm

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Powells Model of Supervision (1993)

• Components
• Administrative
• Evaluative
• Clinical
• Supportive
• Conceptualization of supervisor as a servant
  leader who
• Is self-aware
• Operates with focus energy
• Is proficient in many aspects of the job
• Makes the organizations mission vision clear by
  standing ahead of the followers while standing
  behind their actions
• Shares power
• Values people by caring for them

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Assumptions of Powells Model of Clinical
Supervision (Powell, 1993)

• People have the ability to bring about change in
  their lives with the assistance of a guide.
• People do not always know what is best for them
  as they may be blinded by their resistance to
  denial of the issues.
• The key to growth is to blend insight
  behavioral change in the right amounts at the
  appropriate time.
• Change is constant inevitable.
• In supervision, as in therapy, the guide
  concentrates on what is changeable.
• It is not necessary to know about the cause or
  function of a manifest problem to resolve it.
• There are many correct ways to view the world.

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Structure of Supervision

• Individual 1 to 1
• 1 supervisor 1 supervisee
• Group
• 1 supervisor with 4-6 supervisees
• Triad 1 supervisor 2 supervisees
• Team colleagues working together outside the
  group
• Network people not usually working together
  outside the group
• Administrative Arrangements
• Hierarchical
• Non-hierarchical

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Supervision Venues

• Routine interactions on the job
• Informally
• In scheduled meetings
• Indirectly e.g., by talking to patients
• Through remote communication
• Telephone
• Computer
• Written documentation, e.g., logs, records,
  reports

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Current Supervision Debates

• Qualifications of the supervisors
• From the same discipline
• A different discipline
• A peer colleague
• Expertise
• Content of care
• Processes of development
• Guided reflection vs. more traditional clinical
  supervision
• Collaborative supervision
• May not challenge each other sufficiently (Walsh
  et al., 2003)

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Evidence - Supervision Effectiveness(Kilminster
Jolly, 2000, p. 833)

• Supervision has a positive effect on patient
  outcome lack of supervision is harmful to
  patients.
• Supervision has more effect when the trainee is
  less experienced.
• Self-supervision is not effective.
• The quality of the relationship between
  supervisor supervisee is probably the single
  most important factor for effective supervision.
• Behavioral changes can occur quickly changes in
  thinking attitude take longer.

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Tips

• Combine supervision with focused feedback
• Continuity
• Reflection by both participants

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Characteristics of Effective Supervisors

• Empathetic
• Supportive
• Flexible
• Interested in supervision
• Track supervisees effectively
• Link theory with practice
• Engage in joint problem-solving
• Interpretative
• Respectful
• Focused
• Practical
• Knowledgeable

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Characteristics of Ineffective Supervisors

• Rigid
• Low empathy
• Low support
• Failure to consistently track supervisee concerns
• Failure to teach or instruct
• Indirect intolerant
• Closed
• Lack respect for differences
• Non-collegial
• Lacking in praise encouragement
• Sexist
• Emphasize evaluation, weaknesses, deficiencies

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Recommended Content for Supervisor Training

• Supervision frameworks
• Assessment of learning needs
• Teaching the adult learner
• Counseling
• Provision of feedback
• Issues of power social stratification
• Transcultural relationships

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References

• Heron, J. (1989). Six category intervention
  analysis. Guildford Human Potential Resource
  Group, University of Surrey.
• Kilminster, S. M., Jolly, B.C. (2000).
  Effective supervision in clinical practice
  settings A literature review. Medical
  Education, 34, 827-840.
• Powell, D. (1993). Clinical supervision in
  alcohol and drug abuse counseling. San
  Francisco Jossey-Bass .
• Proctor, B. (1987). Supervision A cooperative
  exercise in accountability. In M. Marken, M.
  Payne (Eds.). Enabling and ensuring supervision
  in practice. Leicester Youth Bureau and Council
  for Education and Training in Youth and Community
  Work.
• Sloan, G., Watson, H. (2002). Clinical
  supervision models for nursing Structure,
  research and limitations. Nursing Standard,
  17(4), 41-46.
• Walsh, K. et al. (2003). Development of a group
  model of clinical supervision to meet the needs
  of a community mental health nursing team.
  International Journal of Nursing Practice, 9,
  33-39.

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QUESTIONS?