Regional Review of Clinical Supervision across the HPSS – Findings, Actions & Implications

1. Regional Review of Clinical Supervision across the HPSS –Findings, Actions & Implications Hazel Baird Executive Director of Nursing & Quality Homefirst Community Trust

2. Review Brief • Review current guidance on CS in the HPSS • Evaluate current CS systems in the HPSS • Establish an action plan for ensuring that effective CS systems are in place. • CNO placed this work within the context of “The DHSSPS Quality Standards for Health and Social Care – Supporting Good Governance and Best Practice in the HPSS”

3. A WORKING DEFINITION OF CLINICAL SUPERVISION “The term ‘clinical supervision’ will include a wide range of activities that have ‘supervision’ impact such as action learning, multi-disciplinary team supervision, reflective learning groups, critical companionship, professional and peer supervision, particularly where such activities are formally identified as being underpinned by similar principles to clinical supervision”. (Clinical Supervision Review Group, June 2006)

4. Process • NIPEC established the CS Review Group (May 06) • Considered current literature and a Briefing paper • Agreed the Review Work Plan • Fieldwork – interviews with all 18 Directors of Nursing and in most cases their senior team (July/Aug 06) • Case-study workshop to analyse exemplars of ‘good’ supervision practice (August 06) • Consultative workshop with key stakeholders to discuss the analysis and findings, and the draft Guiding Principles and Recommended Actions (October 06) • Review Group then agreed the GPs and Action Plan and format of the report (November 06)

5. Interview Analysis

6. How does the organisation define clinical supervision and what activities come under the remit of supervision?

7. The range of activities that fall under a broad definition of clinical supervision are widespread and include: • Team meetings • Action learning • Mentorship • Staff nurse induction and development programmes • Problem-based learning • Critical Companionship • Reflective diaries • Formal clinical supervision (one to one and group) • Informal clinical supervision • Professional supervision • Managerial supervision • Peer supervision • Clinical support supervision • Professional group meetings

8. The level of robustness of organisational frameworks for supervision activities would appear to fall into one of three groups, as follows:

9. Who has led the implementation of CS across the Trust?

10. Can the Trust provide evidence of the number of people undertaking supervision and the regularity of this?

11. What is the level of enthusiasm for undertaking supervision across the organisation? • In some areas enthusiasm is limited, mixed or sporadic • The majority of Trusts suggest there has been a renewed and growing interest in supervision • The term ‘clinical supervision’ is no longer used by a number of Trusts • There is concern for some, that a focus on performance review and KSF is reducing emphasis on supervision

12. Is there protected time allocated for supervision?

13. Has the Trust evaluated supervision methods?

14. How are supervisors/supervisees and managers with responsibility for supervision trained?

15. What records are kept on supervision i.e. contracts and written accounts of sessions, action plans from sessions?

16. Has the Trust faced any barriers to ‘establishing’ supervision? • Negativity, cynicism, lacking acceptance and lacking commitment to the concept of supervision; • Confusion and misunderstandings around what clinical supervision is about; • No one leading or championing the process; • No organisational framework, strategic direction or strong value base for supervision activities;

17. Has the Trust faced any barriers to ‘establishing’ supervision? • The sheer number of nurses across an organisation who would be required to avail of these opportunities; • Lack of a resource infrastructure to enable staff to engage in supervision i.e. funding to protect time for work-based learning, and the demands of service that make it difficult to find time for supervision activities.

18. Has the Trust faced any barriers to ‘sustaining’ supervision and enabling ‘effective’ supervision? • Lack of a big enough pool of experienced and well trained supervisors/facilitators; • Increasingly integrated and cross-boundary working and the potential impact of organisational re-structuring may affect sustainability of these activities; • The increasing expectation on experienced nurses to mentor, teach, assess and supervise practitioners at a range of levels; • Not evaluating supervision activities through a strong monitoring framework, and not fulfilling the need to prove through evaluation that there are benefits to these activities;

19. Has the Trust faced any barriers to ‘sustaining’ supervision and enabling ‘effective’ supervision? • Failing to recognise the importance of placing the wide range of learning and development activities under a single and well resourced organisational framework; • Lack of value from commissioners placed on supervision activities, and the need for appropriate funding streams if all forms of experiential learning are to work alongside formal classroom learning; • Lack of continual and ongoing leadership, drive and commitment.

20. What are the factors that are enabling clinical supervision to work well where this is happening? • Organisational commitment and gifted leadership; • Developed from the bottom up and driven from the top down; • Having a clear vision that becomes a strategic plan and supervision framework; • A strong professional value base that recognises the usefulness of these activities; • A critical mass of people who have the skills in this way of working and facilitation; • Integrated processes, flexibility of approach and working across professional groups;

21. What are the factors that are enabling clinical supervision to work well where this is happening? • Specific strands of project work and a range of developing tools and processes to underpin critical inquiry; • Modernising learning and building up the importance of experiential learning and the time for these activities; • Becoming more aware of the value of reflecting, learning and taking action together, thus increasing confidence; • Reciprocity in that all involved understand and share the benefits of supervision; • Robust evaluation of the processes and outcomes of supervision activities;

22. DHSSPS Review of Clinical Supervision – analysis of case studies presented at the 21st August 2006 workshop

23. The aim of the workshop was to appreciate the best of what is currently available in Northern Ireland on the subject of clinical supervision (and related models of reflective practice that include support, challenge and learning).

24. Supervision Models analysed • One to one clinical supervision • Staff nurse induction and development programmes • Health visiting and child protection supervision models • Action learning

25. The following themes emerged, each seen as crucial factors for effective clinical supervision • Culture of learning and development • Preparation in a range of ways • Strategic Direction is clear • Time to undertake supervision • Strong value base for supervision • Skilled Facilitation Capacity • Overarching Organisational Framework • Structures and Processes in place • Champions of supervision • Organisational Commitment at all levels • Robust Evaluation processes • Valuing reflection-in-action

26. Modernised definition for Supervision (adapted from the NHS Management Executive definition, 1995) ‘Supervision is defined as a process of professional support and learning, undertaken through a range of activities, which enables individual registrant nurses to develop knowledge and competence, assume responsibility for their own practice, and enhance service-user protection, quality and safety of care’.

27. Outcomes of the Review • A set of Guiding Principles and an Action Plan for future Supervision activity across the HPSS • Recommends the development of a Regional Standard for Supervision • Recognises the need for diversity of approach, an appropriate organisational infrastructure, clarity on recording, modern approaches to training for supervision and robust monitoring/evaluation processes

28. Outcomes of the Review (continued) • Focus on the link with governance, individual responsibility and professional accountability, and the complementary nature of supervision and appraisal/performance review for all nurses • The need for consistency of implementation across Northern Ireland • Various levels of responsibility.

29. Levels of responsibility (2007-08)

30. Regional Standards for Supervision Domain 1. Implementation of Supervision – focuses on the organisational framework, appropriate preparation, leadership for supervision, the range of models, and processes of evaluation. Domain 2. Governance of Supervision – focuses on ensuring supervision activities are embedded within the organisational governance and performance monitoring framework.

31. Thank you for listening For further information and to read the review report, please go to – www.nipec.n-i.nhs.uk/devofpracticedocuments.htm