Effective supervision in a variety of settings

Recommendations

You may wish to read the narrative summary [5] to see how we arrived at these 30 recommendations.

People who uses services

1. Supervisors could consider how to involve people who use services in supervision, especially in structured practice discussion and decisions about their care. Supervisors should consider how this involvement can be empowering, non-threatening and emotionally ‘safe’ for people, and sensitive to the power relationships existing between staff and people who use services.

Personal assistants (PAs) have spoken of the positive value of having regular supervision and some people employing PAs have thought about how this might be achieved. Commissioners and national and local policy-makers should consider both the funding of supervision, and how people who use services can be trained to act as supervisors or, at minimum, trained to provide a key input into supervision.

Supervisees

2. The following four elements are associated with a supervisee’s job satisfaction, career or job retention, emotional health and practice skills:

  • task assistance, defined as the supervisor’s ability to provide tangible, work-related guidance
  • social and emotional support in responding to emotional needs, including stress
  • a positively perceived relationship with their supervisor and the extent to which this has helped them to be more effective in their work
  • effective feedback from supervisor to supervisee and how this also supports confident and safe practice, job satisfaction and retention.

Evidence also suggests that longer-term professional development is important to supervisees.

3. Practice and policy suggests that supervisees should be aware of the role of supervision and take an active part in the process. Moreover, codes of practice within health and social care highlight the importance of workers taking responsibility for their own learning and professional development, supported by their employer.

Supervisors’ expertise and training

4. Supervisors need to continually update their expert clinical and practice knowledge and their clinical intervention skills for the specific populations of people with whom their supervisees are working.

5. Organisations may find it helpful to consider, implement and evaluate the following types of training for supervisors of front-line staff and for ‘supervisors of supervisors’:

  • training in generic and specific supervision skills and techniques, such as analysis of practice with specific people, critical thinking, group supervision, feedback and reflection
  • ‘learning laboratories’ to improve supervisory skills in a cycle of improvements
  • staff watching their supervisory performance in audio-visual recordings and reflecting on it
  • group supervision for supervisors to model supervision skills
  • training in performance management, appraisal, coaching, supervising a diverse workforce, conflict management and action learning
  • supporting safe practice – an awareness of how supervisors can offer support to supervisees which takes account of effective safeguarding in case management.

Organisational policy and procedures

6. Practice and policy tell us that organisations should consider supervision as part of their ‘duty of care’. In relation to this, a clear articulation of the purpose and practice of supervision embedded within communication, continuing professional development (CPD) and performance management systems may be of help.

7. Policies, procedures and professional standards should support the practice of supervision, and could be linked to other organisational policies such as sickness and absence, flexible working, health and wellbeing, whistleblowing, grievance, capability, etc., in order to promote and sustain good supervisory practice. Moreover, in order to maintain quality, it may be useful if supervision practice is monitored.

Culture

8. The role of supervision should be understood and valued within the context of the organisational culture. The culture of an organisation is critical in setting the tone, values and behaviours that are expected. Supervision has a part to play in delivering good services and outcomes for people. Workers therefore need to be allowed planning, preparation and supervision time as part of their workload.

Leadership

9. Where the working context is complex, professional leadership may be needed to ensure that support (including supervision) is appropriately accessed by all workers.

10. Senior managers and line managers should consider how they can best create a culture that recognises the value offered by effective supervision at all levels. In turn, effective supervision may increase employees’ perceptions of organisational support and improve their commitment to the organisation and its goals.

11. Supervisors and organisations/agencies should offer regular supervision. In addition to this, it is advisable that supervisors are available at other times, offering an ‘open door’ where possible, and ad hoc and informal supervision when needed, within the constraints of the time available.

12. For home care workers, organisations should offer alternative ‘responsive out-of-hours systems’, especially at times of crises and emergencies as well as regular telephone contact, in addition to scheduled supervision.

13. Each organisation will have its own process and policy in terms of recording supervision. Supervisors and supervisees could use note-taking or structured pro-formas to record decisions and feedback. They may also want to consider how to record reflection and discussion as these are linked to those decisions.

Supervision in multidisciplinary teams

14. Research studies [2] suggest that the availability of a supervisor from the worker’s own profession is important even if only as a model of practice. However, if organisations do not appoint supervisors from the same professional discipline as supervisees, it is advisable to make sure that supervisors understand the professional roles, frameworks, language and values of their supervisees, and have discipline-specific skills and knowledge in order to engage with their supervisees’ work.

In the case of health professionals, clinical supervision can only be provided by a person of the same profession. If an operational manager is from another profession then it is essential that they ensure the supervisee has appropriate clinical support in place.

Cost and cost-effectiveness of supervision

15. Organisations could consider calculating the unit cost of supervision. One study of local authority children’s departments in England has already done this using the salary costs of supervisors and supervisees as well as overhead costs. Lambley and Marrable [2] have noted how costs have been calculated in one non-profit organisation. A cost-benefit analysis could be of particular benefit, however, organisations would need to enlist appropriate expertise.

Task assistance

16. Supervisors could offer an educational role in supervision, and ‘task assistance’ (teaching new skills and interventions, helping with difficult work and giving tangible work-related guidance) with the aim of improving practice and outcomes for people.

17. Structured practice discussions and decisions about specific people have shown in some studies to be of direct use. Practice discussions could have a reflective focus and include ‘constructive challenge of practice’ rather than being mainly concerned with case planning, time management, or monitoring of the supervisee’s work against care plans and lists.

18. Practice suggests that performance review and formal monitoring is linked to quality assurance, managing risk and performance management in organisations, and can be desirable from the perspectives of people who use services and some workers.

19. The responsibilities of qualified professionals within complex organisational systems, and accountability requirements, mean that the type of supervision provided needs to be appropriate to the role. This may require adaptations to or changes in the way in which supervision is organised and delivered.

Emotional support

20. Evidence [2,15,29] suggests that appropriate emotional support can buffer against anxiety, stress and high workloads. Emotional support from supervisors may directly improve staff retention and build perceptions of organisational support.

21. To effectively provide emotional support, it is helpful if supervisors and organisations arrange for supervision to take place in a safe, confidential, quiet, physical space. What has also made a difference is if supervisors are respectful, express empathy for the supervisee, are ‘aware of self’ themselves and use active listening in supervision sessions.

22. Supervisors could specifically offer:

  • debriefing discussions on the emotional impact of specific cases
  • facilitation of reflection on supervisees’ feelings and personal struggles in aspects of their work which make them feel vulnerable as practitioners.

23. Supervisors should aim to build an emotionally ‘safe’, supportive relationship with supervisees, which is positively perceived by them. This includes rapport, trust, confidence and enthusiasm.

24. Supervisors may want to consider strategies, reported in Bourne and Hafford-Letchfield’s [29] qualitative study, to contain anxiety, which include humour, encouragement and recognition.

25. Supervisors should consider how they can give emotional support in a way that does not increase feelings of burnout, but reflects on these feelings in a way that builds positive emotional outcomes.

26. Supervisors may want to consider a more consultative style with more experienced staff, and a more directive style with less experienced staff. They also may want to offer more frequent supervision (than monthly) to staff at the beginning of their careers.

Feedback, reflection and critical thinking

27. Supervisors may wish to consider introducing clear and constructive feedback, reflection and critical thinking into supervision, balancing them appropriately with performance review and formal monitoring.

28. Practice suggests that reflection in supervision can involve critical thinking about practice with specific people. This includes identifying with the worker, any bias and assumptions they may be carrying or practices and behaviours that they exhibit as a result of interacting with specific people who use services.

29. Identifying barriers to effective practice within the organisation could also be discussed and be fed through supervisors to senior managers.

30. Supervisors could give positive reinforcement through recognition and praise for work well done. It may be helpful if feedback is reciprocal. This could include:

  • 360° feedback (perhaps including service user input)
  • feedback from the supervisee to the organisation, and vice versa
  • using the supervisor as a mediator in communication.

It should be recognised that there may be tension between honest feedback from the supervisee and the need for them to appear competent for performance appraisals.

Downloads

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Available downloads:

  • Effective supervision in a variety of settings
  • Service user and carer involvement in the supervision of health and social care workers: seminar report
  • Practice enquiry into supervision in a variety of adult care settings where there are health and social care practitioners working together
  • Narrative summary of the evidence review on supervision of social workers and social care workers in a range of settings including integrated settings