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

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.

A question of attitude…..

A question of attitude Difficult trainees vs Trainees in difficulty

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

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

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

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

How do we measure these outcomes? How do we know if a trainee is in difficulty? For the trainee 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 For patients/organisation Adverse events Complaints

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 yrs into the program, dept decided to act Difficult conversation 6mth remediation program –extra supervision, extra teaching, formal documented feedback Trainee not reemployed

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

Early or late?

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

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

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

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

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

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

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