Providing ‘value’ in clinical supervision

1. Providing ‘value’ in clinical supervision How an ounce of prevention is worth a pound of cure Tracey Tay Staff Anaesthetist HNE Health Clinical Lead NSW Agency for ClinicalInnovation June 11, 2014

2. Key messages • Clinical supervision is essential work and it takes a lot of time and energy to do this well • When a trainee is in difficulty, the longer the problems are left unaddressed, the more work is required • Creating a healthy workplace helps to prevent problems and allows early detection of trainees in difficulty.

3. A question of attitude…..

6. A question of attitude Difficult trainees vs Trainees in difficulty

7. Value • Many definitions • Prof Michael Porter, Harvard Business School • Value-Based Healthcare Delivery • Value = patient outcomes per dollar spent

8. What is ‘value’ in supervision? • Trainee supervision outcomes per resource expended

9. Trainee supervision outcomes • For the trainee • Knowledge • Skills • Behaviours • For patients and the organisation • Safety • Appropriate care • Efficiency • Timeliness • Patient-centred care

10. What are we concerned about? • Performance • Conduct • Impairment • Grey areas • Professional behaviour • Exam preparation • Motivation

11. How do we measure these outcomes?How do we know if a trainee is in difficulty? For the trainee For patients/organisation Adverse events Complaints • Exams – formative, summative • Workplace-based assessments • Direct observation of procedural skills (DOPS) • Mini clinical evaluation exercise (Mini-CEX) • Multisource feedback • Informal discussions with the trainee or other staff • Informal observation

12. Trainee in difficulty • Rotated away on a number of occasions • Corridor and tea room conversations • “Odd behaviour”, “no insight” • Comments by nurses and other team members • 8 yrsinto the program, dept decided to act • Difficult conversation • 6mth remediation program –extra supervision, extra teaching, formal documented feedback • Trainee not reemployed

13. Trainee in difficulty • How fair was this for the trainee? • Would there have been a different outcome if there had been early intervention?

14. Early or late?

15. Early or late?

16. Intervening early - Coach or referee? Score Time (Quarter years)

17. Intervening early – feedback conversations • Daily! • More likely to be specific, timely • Seek training in giving and receiving feedback • Provide a template to get everyone started

18. Intervening early – a healthy workplace • Leadership, role-modelling and being accountable • Heads of department • Supervisors of training • Clinical supervisors • Processes • Clear requirements/criteria for supervision • Rostering for appropriate supervision • Workload/hours of work

19. Intervening early – a healthy workplace • Support structures/people/processes • Orientation • Peer support/buddy systems • Mentors • Agreed ‘above and below the line’ behaviours • Support for ‘speaking up’ • Training • Early access to specialist help

20. Intervening early – a healthy workplace A plea for kindness and compassion

21. Best ‘value’ in supervision is early intervention • Spend time and effort to create a healthy environment • Make giving and receiving feedback an ‘everyday’ thing • Don’t wait for trainees to make a mistake before you intervene

22. Remind yourself, if things aren’t going well, this is a person in difficulty NOT a difficult person

23. tracey.tay@aci.health.nsw.gov.au