1. Supervision and creating culture of reflective practice
“Clinical” vs management supervision
Dr Lynn Suter

2. OUTLINE
Clinical and management supervision: definitions, differences and similarities
What is reflective practice and why is it important?
How does supervision contribute to reflective practice?

3. Managerial supervision

5. Performance management
Performance management is the process of creating a work environment or setting in which people are enabled to perform to the best of their abilities. Performance management is a whole work system that begins when a job is defined as needed. It ends when an employee leaves your organisation.
Performance management defines your interaction with an employee at every step of the way in between these major life cycle occurrences. Performance management makes every interaction opportunity with an employee in to a learning occasion.

6. Performance management
Performance management is not an annual appraisal meeting. It is not preparing for that appraisal meeting nor is it a self-evaluation. It's not a form nor is it a measuring tool although many organizations may use tools and forms to track goals and improvements, they are not the process of performance management.

7. Performance management
Is generally carried our by the line manager
Is linked to the goals of the organisation
Will involve setting individual goals and targets
Any training suggested is usually organisationally focused
It may cover disciplinary issues
If it looks at clinical issues these will usually be operational from the point of view of case load, waiting lists etc.

8. “Clinical” supervision – what is it?
Skills for Care (2007) define ‘supervision’ as “an accountable process which supports, assures and develops the knowledge skills and values of an individual group or team”.
In some professions and occupations, alternative titles may be used, such as ‘peer supervision’, ‘developmental supervision’, ‘reflective supervision’ or just ‘supervision’, but generally clinical supervision is seen as complementary to, but separate from, managerial supervision, which is about monitoring and appraising the performance of staff.
Care Quality Commission – Supporting Effective Supervision

9. Clinical Supervision – what is it?
There is no one way to do clinical supervision, but there are a few principles…
clinical supervision allows a person to focus on a particular aspect of their clinical practice in a way that they would not normally do
it is characterised by reflection on previous action and its implications for future action; a clinical supervisor will often challenge the supervisee to think outside of their current ways of working

10. Clinical supervision – what is it?
the clinical supervisor will offer support and advice; the supervisee tends to learn alternative ways of working and specific skills
the clinical supervisor will be interested in the quality of the supervisee’s performance and will offer constructive feedback
NHS Flying Start

11. Clinical supervision – what is it?
Clinical supervision provides a safe environment for clinicians to actively engage with each other to reflect on their clinical practice and improve standards of care.
It allows them to think proactively and find solutions to problems, eg, dealing with difficult situations or conflict.
Many of the professional issues we face can be challenging and overwhelming, but being able to discuss these with peers can only enhance practice and individuals understanding of these to ultimately benefit practice in the wider context.
The process of supervision facilitates the individual to develop knowledge and competence, and link theory and research to practice.
Nursing in Practice

13. Clinical Supervision
Supervisor is external to the organisation, individual or group
All issues may be aired.
The focus is on the client and the work being done with them
Support is provided for the practitioner
Training may be specifically focused on an issue the practitioner is dealing with
It is confidential unless there are ethical reasons to break confidentiality

14. “Clinical” and Managerial
Differences
The focus
Issues dealt with
Target setting
Confidentiality
Person conducting the session
Similarities
Relational
Supportive
Developmental
Challenging
Based on good practice

15. Reflective practice

16. Reflective Practice
“Reflective practice is learning and developing through what we think happened on any occasion, and how we think others perceived the event and us, opening our practice by scrutiny by others, and studying texts from the wider sphere” (Bolton, 2005)

17. Reflective Practice
Reflective Practice is the foundation of professional development; it makes meaning from experience and transforms insights into practical strategies for personal growth and organisational impact.
It involves integrating activities into daily life on a routine basis which raise awareness, prompt critical analysis and aid self-management and decision-making. It means:
Learning to pay attention – listening to ourselves
Coming face to face with our assumptions
Noticing patterns
Changing what we see
Changing the way we see.

18. Reflective Practice

19. Reflective Practice

20. Reflective Practice

21. Reflective Practice More than just reflection
Usually something will be written down
Action plans
Conclusions
Outcomes
Learn from what you did well not only from what you may not have done so well

22. Using reflective practice, we can:
Work with professional and personal relationships
Or dialogue with events or ‘parts’ of self
Critically review our decision making process
Look at hesitations, skill and knowledge gaps
Relieve stress by looking at painful or problem episodes
Rediscover forgotten areas
Discover learning needs
Increase confidence in our practice

23. Group work
Think about when you are being supervised or when you are supervising others…..
Does your supervision include encouragement towards reflective practice?
If yes, what is it that facilitates this happening, what do you or what does your supervisor actually do?
If no, what could you or what could your supervisor do to ensure that some reflective practice occurs?