1. Conducting supervisory visits and feedback
Planning a national SME system for malaria elimination: Reporting, Action, Feedback
Conducting supervisory visits and feedback
By Walter M. Kazadi
Coordinator
ERAR – GMS, WHO WPRO/SEARO
GMS Malaria Elimination Course
10 – 21 August 2015, Chiang Mai, Thailand

2. Learning objectives: By the end of this section, you should be able to
Have better understanding of the principles of supportive supervision
Demonstrate skills in preparing and conducting supervisory visit
Provide appropriate feedback to implementers

3. What is supervision?
Support system aimed at improving knowledge, attitudes and skills of health staff, and the quality of health programmes
Purpose of Supervision: Improve programme efficiency and effectiveness)
accessed 22/09/2012

4. Other terms for Supervisor
Trainer
Advisor
Mentor
Facilitator
Coach

6. Supportive vs. Punitive Supervision
Characteristics
Supportive
Punitive
Objectives
identify problems and help health workers solve them.
To recognize good performance.
To show health workers that their performance matters.
To identify flaws and reprimand those
responsible
Technical basis
Behavioural science, communication skills
and programme planning are all important technical skills.
No technical basis used in interpersonal
contact

7. Supportive vs. Punitive Supervision
Characteristics
Supportive
Punitive
Tools and methods
Diverse strategies to assess and understand the situation
Observation of practices and environment
Listening to concerns and offering help
Sharing information
Good communication skills
Inflexible use of checklists
Judging based on assumptions, impressions
or hearsay
Intimidation
Withholding information
Poor communication skills
Feedback
Recognizes achievements.
Focuses on problems that are solvable.
Offers training
and support.
Very little positive feedback.
Feedback is usually unstructured and critical.

8. Exercise 1: Improve the organization of supervisory visits
Purpose: Answer questions about supervision and plan how to improve organization of supervision in your programme
Using your own experience, select one intervention, identify problems and plan for supervisory visits? What could you do to manage these problems?
Intervention: ……………………………………………
Problems
How to manage (solutions)

9. Exercise 1: Improve the organization of supervisory visits
Based on identified problems, outline an improved organization of supervisory visit for the intervention you have considered
Where
What and who to supervise
Supervisory methods
When:
Frequency
Who will conduct sup. visits
Other interventions that could be supervised at the same time
Community
Health Facility
District level
Provincial level
Central Level

10. What to supervise: Questions to consider
What are the key tasks of clinical practice or case management performed by health staff that should be checked against the technical standards?
In what activities is there a failure to perform adequately? What specific failures would seriously interfere with the success of the programme?
What tasks and activities are the most difficult or challenging for health workers?
What tasks and activities are new to health workers?
What do the clients complain about?

11. Methods used during supervisory visits
Observation
Dialogue/discussion
Review of records
Exit interviews
Community interviews
Good supervision involves interaction,
is supportive, not punitive!

12. Frequency of supervisory visits
Frequently enough to provide needed support
Monthly to health facilities and community level
Quarterly to districts
Every six months to Provincial level

13. Who should conduct supervisory visit?
Consider :
geographic proximity
Activities or tasks to be assessed (clinical vs. administrative)
Previous training/experience of the supervisor (including use of supportive techniques)
Who will be supervised (nurse, clinician, data entry clerk, lab technician?)
Availability

14. Exercise 2 – Role Play: Conduct supervisory visit, give feedback and solve problems
For this part of the exercise, you will practise conducting a supervisory visit, and giving feedback . One person will play the role of the supervisor and one will play the role of a health worker at a first-level health facility.

15. Scenario 1
Health Centre setting (2 health workers attending to a patient in the OPD)
Supervisor comes in unannounced (walks in hands inside pocket)
Asks for all staff member to assemble (stands akimbo)
Takes roll call (identifies absentees)
Ask staff members if they know his position
Introduces himself

16. Scenario 1… Told them of his mission Asks for some documents
Scribbles down some few notes
He told the staff members present, “all absentees will hear from the Headquarters very soon”
He departs, fuming (without any guidance)

17. Scenario 2
Health Centre setting (2 health workers attending to patient in the OPD)
Supervisor and team comes in (apologises for slight delay in arrival)
Exercises patience while health work concludes consultation
Introduces himself and his colleagues
He explains his mission (referring to a letter sent to HF earlier)
He asks after the staff family, work, welfare, etc
Jointly they all reviewed some documents and discussed for a while

18. Scenario 2…
He paid a courtesy call on the Head of the Town to thank him for his support
He asked staff members to call him if there are more issues to be discussed
He promised to share his report before sharing with the higher authority
Staff saw him off to his vehicle (waving happily as he departs)

19. Tasks during role pay by other members of groups
Note:
Steps taken to prepare for the visit
Steps during the visit
verbal and non-verbal communication
whether the problem was clearly described
whether causes were analysed and the health worker’s ideas were considered
whether the solutions to the problem were agreed, and
whether the health worker had a chance to raise other concerns or questions.

20. Tasks after role pay by other members of group
Discuss whether the appropriate steps were taken during the role play and the manner of the feedback.
Other participants will act in additional role plays, as time allows.

21. 7 skills for effective supervision
Listening
Availability (physically and mentally)
Mission focus and priority/action oriented
Transparency
Delegation
Responsibilities (clear expectations and regular feed back)
Authority (decision making)
Accountability (for results)
Taking responsibilities and giving credit
Realism (Do not promise heaven)
accessed 22/09/2012

22. Steps to prepare for a supervisory visit
Review past performance at the facility/health service
Find out about follow-up actions
Collect appropriate checklists and recording forms
Prepare to inform staff at the facility of any updates, plans
Collect supplies, equipment, and/or materials that can be delivered
Collect materials to take so that you will be prepared for problem solving
Confirm logistic arrangements

23. Steps to conduct a supervisory visit
Private interview with the person in-charge
A review and assessment of current practices, procedures, logistics (walk about)
A technical assessment of the performance of the health workers and the health services
A discussion of perceptions of services and activities with caregivers
Feedback of results
An opportunity for health workers to ask questions
Problem solving
Plan for next steps.
Action after the visit

24. How to conduct a problem-solving discussion
Identify the likely cause (causes) of the problem
Responsibility of the task clearly assigned?
Health workers lack necessary knowledge and skills?
Health workers lack motivation?
Are there obstacles (time, authority, funds, supplies, etc.)
Define one or more feasible solutions

25. Techniques for giving feedback
Comments task oriented
Feedback should be prompt
Motivating
Action-oriented
Constructive

26. Key supervisory tasks Motivate Provide feedback
Resolve performance problems
Blend employee goals with work requirements
Improve communications and keep employees informed
Responsible for employee training and skills
accessed 22 September 2012

27. Attributes of a good supervisor
Excellent communication skills
Fairness (in delegating tasks)
Good organizational skills
Knowledge of the subject
Accountability
Efficiency (right task to the right person)
Adaptability
Social skills (culture sensitive, polite but assertive)
Diplomacy (managing different expectations)
Self-discipline
accessed 22 September 2012

28. Take home messages
Supportive supervision, an essential component of programme management cycle (Plan – Do – Check – Act)
Supportive supervision is informed by the needs: importance of the “what and who is supervised, how, when, and by whom”
Good preparation and systematic approach enhances the effects of the visits
Good feedback should be task oriented, prompt , motivating, action-oriented and constructive

29. Thank you!