Effective supervision in a variety of settings

The context for effective supervision: Developing a supervision policy

A supervision policy is the means by which an organisation establishes its commitment to supervision, clarifies expectations regarding the standard of delivery and decides upon how the process will be reviewed and evaluated. The policy will also need to identify how the organisation will support the process with resources, including the training and development of supervisors.

The stages involved in developing a supervision policy might be:

• a review of current supervision arrangements against current professional standards and expectations, incorporating feedback from supervisors, supervisees and people who use services
• agreeing at a senior management level the definition of supervision on which the policy will be based, the key principles that will underpin the delivery of supervision within the organisation, and the expected outcomes
• establishing the model of supervision on which the policy will be based and the expected outputs (e.g. frequency, recording methods, core areas for discussion)
• consideration of how the quality of supervision and outcomes for key stakeholders will be evaluated.

Does your supervision policy state:

• the principles underpinning supervisory practice within your organisation (e.g. it is a priority activity; it is focused on ensuring best practice with people who use services etc.)?
• the roles and responsibilities of the organisation, the supervisor and the supervisee?
• expected frequency of supervision?
• the importance of a supervision agreement and what this might look like?
• expectations regarding recording?
• how supervision practice will be monitored and evaluated?

Any supervision policy will need to be clear about the definition of supervision being used and the interface between the definition and the role and responsibilities of supervisors within the organisation.

The research underpinning this guide identified three types of supervision:

• management: task-orientated to deliver specific organisational outcomes [2]
• professional: focused on the work being carried out with people who use services [2]
• clinical: focused on professional support and learning which enables individual practitioners to develop knowledge and competence and assume responsibility for their own practice.[7]

Other guidance [17] has referred to supervision as involving:

• line management (accountability for practice and service quality)
• professional supervision (case supervision)
• Continuing Professional Development (CPD).

When using these frameworks it is important to ensure that the need to include emotional support within the supervision process is considered. It is one element of clinical supervision and the detailed Skills for Care/CWDC document [17] refers to ‘support’ and ‘duty of care’ under line management.

It is also important that supervisors do not see supervision as a fragmented activity with case discussions being divorced from the support, development and managerial aspects of the role. While there may be reasons why a staff member might need professional or clinical supervision in addition to managerial supervision (e.g. if their manager is from a different professional background), the prime goal should be to make sure that, however supervision is delivered, the staff member is managed and held accountable for their work, assisted to critically reflect on their work with people who use services, supported in their role and provided with development opportunities.

In order to ensure that all the elements of these types of supervision are enshrined in practice, the definition by Morrison, [1] which is widely used within social care, provides a useful framework for policy development, particularly as it clearly identifies the importance of emotional support. For Morrison, supervision is: ‘a process by which one worker is given responsibility by the organisation to work with another worker(s) in order to meet certain organisational professional and personal objectives which together promote the best outcomes for service users’.

The objectives and functions of supervision have been described by Morrison as:

• competent accountable performance (managerial function)
• CPD (developmental or formative function)
• personal support (supportive or restorative function)
• engaging the individual with the organisation (mediation function).

The importance of this definition is that supervision can be seen as an integrated activity and case discussions address all four functions.

• Figure 1: Integrated nature of supervision

The definition has led to the development of the integrated model of supervision, sometimes referred to as the 4x4x4 model,1 which may be useful in some social care contexts and could be used to deliver managerial, clinical and professional supervision. Within this model the term ‘management’ is used broadly to refer to the role that any supervisor has (whether or not they are the supervisee’s line manager) in being accountable for the advice supervisees are giving and any practice decisions that emerge from supervision. All supervisors, whether clinical, professional or managerial, will also have a responsibility to report any unsafe or dangerous practice. This model acknowledges the interdependence of all four functions of supervision, their impact on key stakeholders and the four stages of the supervision cycle. The supervision cycle is a process for delivering supervision which ensures a focus on all four functions and is explored further in the foundations of effective supervision practice section of this guide.

Table 1 Integrated model of supervision

At the heart of the 4x4x4 model is the principle that supervision is part of intervention with people who use services. It is not an add-on activity but one which is intimately linked with the quality of the service received and the degree to which the service has a positive impact on the lives of people who use services. Morrison refers to this as the ‘supervision-outcome chain’, a process that has seven factors linking the quality of supervision to eventual outcomes for people who use services (see Morrison and Wonnacott) [4].

• Figure 2: Supervision outcome chain

You may wish to consider how far the supervision culture and process within your organisation promotes these seven factors. Think about the following questions:

• Is your supervision policy clear about the roles and responsibilities of supervisors and supervisees?
• Does the policy promote a supervisory relationship where supervisees are able to explore confusions, anxieties and dilemmas in order that they develop a sense of security in their role?
• Does the organisation promote the importance of emotionally intelligent practice, including empathy and emotional attunement, both within supervision and with people who use services?
• Is the quality of supervisory relationships evaluated in relation to how successfully they facilitate a culture of openness, where the quality of the supervisee’s practice can be accurately assessed?
• Is supervision based on a balanced use of authority (neither collusive nor punitive), mirroring practice, which is underpinned by a partnership approach and the principles of anti-oppressive practice?
• Does supervision practice integrate with broader opportunities for practice learning and development such as mentoring, shadowing and co-working?
• Do supervision records demonstrate clear plans both for the development of the supervisee and for work with people who use services? Are these plans based on both reflection and analysis of the issues?
• How often do you focus on practice issues in supervision?