Develop the right clinical supervision model

An article published on the hub at the beginning of this year put forward the point that evidence-based practice, based on up-to-date research could be more prevalent if research was explored as part of clinical supervision.

Having been involved in the inception, training and evaluation of a clinical supervision model for allied health professionals in the West Midlands for more than 10 years, we believe we can contribute to the clinical supervision debate.

Occupational therapists do not carry out interventions that directly affect a person’s chances of living and dying. However, in many settings, OTs do pass judgement on whether a patient can live at home in safety, taking into account a myriad of functional, environmental and social factors.

‘None of our supervisors, or supervisees, had been trained in supervision, nor were we following any evidence-based model’

Twelve years ago, there was an official complaint about our department. It transpired that after an OT assessment home visit, the patient in question had been discharged. The next morning he was found dead at the foot of the stairs by a neighbour. The family’s contention that the OT’s judgement had been faulty was just one element of the complaint and one that had to be treated with the utmost seriousness.

The nature of the hospital complaints system meant that this letter arrived many months after the incident. When initial investigations were made, the OT in question had left the hospital some time ago and enquiries made to Health Professions Council and the British Association of Occupational Therapists did not advise tracing the individual as their actions did not form the crux of the complaint. 

What came under the spotlight, therefore, was the department’s clinical supervision protocol and practice. I breathed a sigh of relief. I had evidence of times and dates and content of supervision with this individual, all consistent with the policy. What made me uncomfortable was that none of our supervisors, or supervisees, had been trained in supervision, nor were we following any evidence-based model and, as a manager, I could not vouch for the quality of supervision being given. 

Recommended supervision types

There are two main types of supervision recommended by all the AHP professional bodies and the Royal College of Nursing: management supervision; and clinical supervision. Both of these are imperative to engaging in continuous professional development throughout working life, but each has a different emphasis.

Our supervision regime at the time would be classed as managerial. It was part of the appraisal process, taking place less frequently as the therapist’s experience grew and always delivered senior to junior. 

According to Royal College of Speech and Language Therapists, management-led supervision:

• enables the practitioner to fulfil their job description;
• provides information for carrying out individual performance review;
• encourages and supports therapists in following through objectives set during the formal appraisal;
• gives advice on managing caseloads and any problems affecting the day-to-day functioning of the service;
• facilitates practitioners’ adherence to professional standards and codes of conduct;
• enables discussion of professional development needs in relation to service delivery;
• assists the practitioner in relating practice to theory and theory to practice, thereby promoting continuing education and development.

Clinical supervision was defined by the Department of Health (1993) as: “A formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations.”

In simple terms, management supervision seeks to support the objectives of the organisation, through the safe working of its staff. Clinical supervision seeks to support the individual, developing maturity of thought and confidence in action.

There is, however, an important link between the two. Under the knowledge and skills framework, personal development review of individuals is required to show they have reflected on practice, regularly, throughout the year. Undertaking clinical supervision, and recording reflections made during it, can fulfil this without the need for additional effort or duplication.

‘Management supervision seeks to support the objectives of the organisation, through the safe working of its staff’

Continuous professional development also encompasses training, reflection on practice and translating theory into practice. It is the latter that was the main concern of the previous article, and while it is valuable for an individual to read, analyse and discuss research, it is often the team or those that lead a team that can decide to change practice on the basis of new evidence. So team activities such as journal clubs may be a more productive venue for speeding up the progress of modern practice.

Many healthcare practitioners may not have access to consistent, evidenced supervision, of either kind – despite policies being in place. The confusion about what supervision is, and how it should be delivered, is still common among managers, commissioners and practitioners. Provision of training for supervisors and supervisees is limited to one-day courses or cascade training “on the job”, and has to be generalised if there is no supervision model in place.

It has been shown that hospitals with better human resources practices – regular appraisal, robust training policy and strong team-working identity among staff – have better patient outcomes in terms of mortality. This seems to support our belief that if everyone is trained to deliver supervision to the same model and protocol there will be greater team cohesion and potentially better outcomes for patients.

Clinical supervision model

So we developed a non-managerial clinical supervision model, a project that developed a model and protocol of clinical supervision for AHPs and other autonomous practitioners. 

It was evaluated after two years and has just reached its 10th year in existence. In the additional material we have provided a breakdown of the most recent evaluation as well as more detail about the model, protocol and training. 

This is offered in the spirit of sharing good practice, and because we are proud of what has been achieved. However, our real message is that there is no excuse for AHPs or any other healthcare provider to be weak on clinical supervision. 

You should find a model that suits your service and set up the necessary training for all the staff, and devise your protocol for ensuring it takes place. Also, full responsibility should be taken to review it annually, in a meaningful way. A model and protocol should reflect current need and should not be set in stone. Don’t wait for a serious incident to occur before you take action on clinical supervision.

Helen Tomes and Jane Hill are occupational therapists and non-managerial clinical supervision trainers