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Perspectives about and Models for Supervision in the Health Professions

Perspectives about and Models for Supervision in the Health Professions. Violet H. Barkauskas, PhD, RN, MPH, FAAN The University of Michigan . Focus of the Presentation. The context of health care Frameworks for supervision in health care Examples of framework application

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Perspectives about and Models for Supervision in the Health Professions

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  1. Perspectives about and Models for Supervision in the Health Professions Violet H. Barkauskas,PhD, RN, MPH, FAAN The University of Michigan

  2. Focus of the Presentation • The context of health care • Frameworks for supervision in health care • Examples of framework application • Evidence of effectiveness

  3. 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

  4. 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

  5. Proctor’s 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

  6. 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

  7. Heron’s Model of Supervision (1989) • AuthoritativeSupervision Interventions • Prescriptive – direct behavior • Informative – give information/instruct • Confronting – challenge • FacilitativeSupervision Interventions • Cathartic – release tension/strong emotion • Catalytic – encourage self-exploration • Supportive – validate/confirm

  8. Powell’s 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

  9. Assumptions of Powell’s 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.

  10. 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

  11. 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

  12. 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)

  13. 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.

  14. Tips • Combine supervision with focused feedback • Continuity • Reflection by both participants

  15. 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

  16. 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

  17. 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

  18. 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. References

  19. QUESTIONS?

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