Clinical Supervision Policy Jan 2016 - NHS Doncaster CCG · Clinical supervision is a designated...

CLINICAL SUPERVISION POLICY

Last Review Date

Not Applicable

Approving Body

Quality & Safety Committee

Date of Approval

7 January 2016

Date of Implementation

Next Review Date

January 2019

Review Responsibility

Head of Quality

Version

1

REVISIONS/AMENDMENTS SINCE LAST VERSION Date of Review Amendment Details

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CONTENTS

Page Definitions Section A – Policy 1. Policy Statement, Aims & Objectives 5 2. Legislation & Guidance 5 3. Scope 6 4. Accountabilities & Responsibilities 6 5. Dissemination, Training & Review 8 Section B – Procedure 1. Induction 10 2. Standards and Practice 11 3. Monitoring Compliance and Effectiveness 14 4. References 15 Appendices A Equality Impact Assessment 16 B Process for requesting Individual Supervision 18 C Process for requesting Group Supervision 19 D Clinical Supervision Contract 20 E Record of Supervision Activity 21 F Supervision Record 22

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DEFINITIONS Term

Definition

Clinical Supervision

Clinical supervision is a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care (DOH 1993) Clinical supervision is a designated interaction between two or more practitioners within a safe environment that enables a continuum of reflective critical analysis of care, to ensure quality patient services, and the wellbeing of the practitioner. Bishop and Sweeney, 2006 cited in Bishop V (2007) Clinical Supervision is a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex situations’ (NMC 2006 p6)

NHS Doncaster CCG

NHS Doncaster CCG is the brand name for the organisation legally known as Doncaster Primary Care Trust.

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SECTION A – POLICY 1. Policy Statement, Aims & Objectives 1.1 Clinical supervision is a process by which professionals are assisted to

improve practice, develop both professionally and personally, and manage complex situations associated with the care and treatment of patients. It is a method of supporting and developing competence by providing practitioners with the opportunity to meet either on a regular or adhoc basis with an experienced colleague or peer to discuss, reflect and learn from their experiences in clinical practice.

1.2 The aims of this procedural document are:

• To provide a clear understanding of supervisory processes at Doncaster CCG that focus on the personal and professional development of clinical staff.

• To provide a framework for reporting of supervisory activity undertaken, which can then be reported for governance purposes.

The primary aim of clinical supervision is to facilitate and develop staff in order to ensure the service user / patient receives high quality care. In addition it:

• Contributes to improved clinical practice.

• Enable clinicians to become more self-aware, self-assured, assertive and confident.

• Provides guidance for individual development and skills progression.

• Broadens thinking through problem solving.

• Provides the opportunity for clinicians to feel supported and motivated.

• Improves professional development processes.

• Can oversee the wellbeing and safety of the public, patients, staff and service users.

1.3. To ensure continuous improvement, the organisation has a range of

key performance indicators (KPIs) which it uses for monitoring purposes:

No. Key Performance Indicator Method of Assessment 1. 2.

2. Legislation & Guidance 2.1 The following guidance and legislation has been used in the

development of this policy and procedure:

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• Nursing and Midwifery Council (2006, page 6)

• Department of Health (1993) 3. Scope 3.1. This policy applies to those members of staff that are directly employed

by NHS Doncaster CCG and for whom NHS Doncaster CCG has legal responsibility. For those staff covered by a letter of authority / honorary contract or work experience this policy is also applicable whilst undertaking duties on behalf of NHS Doncaster CCG or working on NHS Doncaster CCG premises and forms part of their arrangements with NHS Doncaster CCG. As part of good employment practice, agency workers are also required to abide by NHS Doncaster CCG policies and procedures, as appropriate, to ensure their health, safety and welfare whilst undertaking work for NHS Doncaster CCG.

3.2 This policy has been developed for all clinical staff working within the DCCG. 3.3 This policy is a framework for clinical supervision that can be used

locally to develop models and systems suited to local need. 3.4 Clinical supervision is an additional means of support and development

and does not seek to replace managerial supervision. The role of the line manager, providing supervision for their staff is an important part of ensuring effective performance is maintained.

4. Accountabilities & Responsibilities 4.1. Overall accountability for ensuring that there are systems and

processes to effectively for Clinical Supervision lies with the Doncaster CCG Governing Body. Responsibility is also delegated to the following individuals:

Directors

Has delegated responsibility for:

• An annual audit is undertaken to ascertain the robustness and adequacy of the clinical supervision systems and structures.

• Regular audits will take place to ensure the quality and effectiveness of supervision.

• Staff are in receipt of regular clinical supervision which meets the needs of the area and its staff.

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Line Managers


• Recognising the benefits that clinical supervision provides for staff and highlighting staff for whom this would be a particularly useful mode of personal and professional development.

• Providing time for clinical supervision within working hours.

• Providing on-going managerial supervision for all their staff.

Supervisors / Coaches


• Providing an environment in which the supervisee feels safe to explore potentially difficult situations, behaviours and attitudes.

• Ensuring that they focus on the developmental needs of the supervisee and maintain a non-judgmental approach.

• Utilise appropriate skills to ensure that supervision sessions are effective and purposeful.

• Agree with supervisee at the outset regarding any communication that will take place with the supervisee’s line manager.

• Maintain supervision/coaching records.

• Complete a record of supervisory activity and return this to the Learning and Development Department quarterly.

Individual Staff

Responsibilities of Staff (including all employees, whether full/part time, agency, bank or volunteers) are:

• Actively engaging in clinical supervision activities in accordance with the requirements from their professional body.

• Ensuring that they take up supervision to meet their personal and professional development needs.

• Recognising that supervision is a positive and effective means of improving performance and supporting development. It is not solely aimed at improving poor performance.

• The direction of their supervision and identification of areas of practice that could be explored in a supervisory session.

• Maintaining a record of learning from supervision/coaching in their personal professional portfolio.

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5. Dissemination, Training & Review 5.1. Dissemination 5.1.1. The effective implementation of this procedural document will support

openness and transparency. NHS Doncaster CCG will:

• Ensure all staff and stakeholders have access to a copy of this procedural document via the organisation’s website.

• Communicate to staff any relevant action to be taken in respect of complaints issues.

• Ensure that relevant training programmes raise and sustain awareness of the importance of effective complaints management.

5.1.2. This procedural document is located in the Clinical Policy Manual. A set of hardcopy Procedural Document Manuals are held by the Governance Team for business continuity purposes and all procedural documents are available via the organisation’s website. Staff are notified by email of new or updated procedural documents.

5.2. Training 5.2.1. All staff will be offered relevant training commensurate with their duties

and responsibilities. Staff requiring support should speak to their line manager in the first instance. Support may also be obtained through their HR Department.

5.3. Review 5.3.1. As part of its development, this procedural document and its impact on

staff, patients and the public has been reviewed in line with NHS Doncaster CCG’s Equality Duties. The purpose of the assessment is to identify and if possible remove any disproportionate adverse impact on employees, patients and the public on the grounds of the protected characteristics under the Equality Act.

5.3.2. The procedural document will be reviewed every three years, and in

accordance with the following on an as and when required basis:

• Legislatives changes

• Good practice guidelines

• Case Law

• Significant incidents reported

• New vulnerabilities identified

• Changes to organisational infrastructure

• Changes in practice

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5.3.3. Procedural document management will be performance monitored to ensure that procedural documents are in-date and relevant to the core business of the CCG. The results will be published in the regular Governance Reports.

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SECTION B – PROCEDURE 6. Introduction

6.1 Doncaster Clinical Commissioning Group (DCCG) is committed to

providing high quality patient centred care in all areas that we serve. This is achieved through the efficient and effective use of resources to provide a comprehensive range of services.

6.2 The DCCG has a clinical quality team that is made up of nursing and

allied health professionals. The team also has the responsibility for the provision of Continuing Healthcare. Staff are our most important resource therefore; the facilitation of highly competent patient focused, experienced and resourceful staff is a key requirement of achieving a high quality service.

6.3 Clinical supervision is a process by which professionals are assisted to

improve practice, develop both professionally and personally, and manage complex situations associated with the care and treatment of patients. It is a method of supporting and developing competence by providing practitioners with the opportunity to meet either on a regular or adhoc basis with an experienced colleague or peer to discuss, reflect and learn from their experiences in clinical practice.

6.4 There are many definitions and models relating to clinical supervision.

The following definition from the Nursing & Midwifery Council (2006) is useful in health care settings.

A formal process of professional support and learning which enables

individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex situations (NMC 2006, page 6).

6.5 The value of effective professional supervision is recognised by the

majority of health associated bodies including the Nursing and Midwifery Council, Chartered Society of Physiotherapists, etc.

6.6 Coaching and mentoring are also recognised as an effective means of

supporting individuals to develop both personally and professionally. Coaching and mentoring can be defined as ‘learning relationships which help people to take charge of their own development, to release their potential and to achieve results which they value’ (Connor & Pokora 2007 p11).

6.7 Whilst coaching and mentoring can be viewed as complementary and

have many similarities, such as facilitating insight, learning and change through a one to one relationship, there are some more distinct

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differences between the two approaches. Mentoring is often undertaken by a more senior person who has experience or achieved success within the same field as the ‘mentee’ and may include a level of professional guidance direction and support. Coaching can be undertaken by an individual who does not have experience within the same field as the ‘coachee’ and is more focused on facilitating the coachee to find their own answers and potential.

6.8 Clinical supervision is part of the clinical governance agenda,

supporting safe, high quality patient care; promoting professional development, and fostering an open culture of learning from both positive and negative events and replicating best practice. Clinical supervision in the workplace is a way of using reflective practice and experiences as part of continuing professional development.

7. Standards and Practice 7.1 Principles of Supervision

The Chartered Society of Physiotherapy (2005) defines the principles of supervision as follows:

• Support and enhance practice for the benefit of patients.

• Develop skills in reflection to narrow the gap between theory and practice Involve a supervisor and practitioner/group of practitioners reflecting on and critically evaluating practice.

• Be distinct from formal line management supervision and appraisal

• Be planned and systematic and conducted within agreed boundaries.

• Be explicit about the public and confidential elements of the process.

• Define an outcomes based action plan. Outcomes can then be more broadly developed to assist the practitioner’s professional development through the Performance Development Review (PDR) process with their line manager/reviewer.

What it is:

• A confidential, safe and supportive environment, to critically reflect on clinical practice. A forum for improving the quality of patient care and individual clinical practice through self-reflection and enhanced self-awareness.

• An opportunity to explore developmental needs and to learn and develop new skills.

• An opportunity to learn from negative and positive events in order to replicate best practice.

• An opportunity to express feelings, consider new perspectives and identify solutions.

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• A forum for minority professional groups to feel supported to minimise professional isolation.

• An environment that supports the safe high quality delivery of patient centred care.

What it isn’t:

• Forum for identifying problems without identifying solutions.

• For resolving personal or professional conflicts.

• For resolving poor performance or disciplinary issues.

• Line management supervision.

• An opportunity to collude with poor practice or undermine individuals.

9.2 Informal Supervision

Whilst this policy focuses on the provision of supervision in a formal setting, it is acknowledged that some staff participates in informal supervision with colleagues outside the work setting. This can be a valuable learning experience; however, Doncaster CCG encourages staff to engage in formal supervision to ensure that it remains a meaningful and constructive process and to gain maximum benefit for patient care. Episodes of informal supervision will not be recorded as supervision activity.

9.3 Group Supervision

Supervision can be undertaken as an individual practitioner or with a group of practitioners. A group can consist of singular or mixed professional/occupational groups. The principles of group supervision are the same as that of individual supervision. However, greater consideration needs to be made to the establishment of ground rules at the start of the process and there should be a shared common purpose between the group members.

9.4 Process for requesting supervision

The processes for requesting individual and group supervision are outlined in a flow chart in appendices 3 and 4 respectively.

9.5 Supervision for Nurses and Midwives at band 7 and above

The Nursing and Midwifery Strategy 2013 encourages the participation of all nurses and midwives in clinical supervision. However, the strategy identifies a mandatory requirement for all nurses and midwives at band 7 or above to undertake clinical supervision.

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Clinical Supervision can be used as evidence as part of Continuing Professional Development (CPD), as this includes coaching/mentoring, but may also be used in individual evidence for Practice related development (five pieces of evidence over the three year period). It is the responsibility of each individual nurse to make arrangements for their supervision which can be undertaken on an individual basis or as part of a group. Nurses who are undertaking a coaching programme do not need to participate in additional clinical supervision unless they specifically choose to do so. Nurses at band 7 or above are expected to undertake a minimum of two clinical supervision sessions per year.

9.6 Confidentiality

The supervision process is confidential between the supervisor and the supervisee. Any discussion of the content of a supervision session should not be discussed outside of the session without the agreement of both parties. However, should a situation arise where maintaining confidentiality would put patients or others at risk of harm, the supervisor is required to take appropriate action.

9.7 Documentation and Reporting

As a minimum the supervisor must record the date, time name and workplace of supervisee on the supervision record sheet (appendix 5) for all supervision sessions. Before starting supervision with an individual or group the supervisor must explain that this type of record of their supervision will be maintained and used in reports to demonstrate levels of supervision activity. These reports do not include the names of individual supervisees nor do they contain any detail of the content of a supervision session. They simply record that the activity has taken place.

Supervisors are encouraged to maintain records of their supervision session although this should be agreed with their supervisee at the start of the process. Supervisor records are encouraged as they form a useful reference point for future session, are helpful in the evaluation of progress and are a reminder regarding the agreement of actions. Supervisors may develop their own record template or Utilise the one found at appendix 6. Supervisees are encouraged to keep records of supervision for their personal professional portfolio. In this instance any reference to patient care/ colleagues/visitors etc should be anonymous. Written reflections

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on learning that has taken place as a result of supervision are encouraged.

9.8 Supervision and Development for Supervisors

Supervisors for registered professionals will have a minimum of two years post registration experience and will undertake a form of taught preparation for their role. This could be a coaching course (or equivalent) with external accreditation but may also be an internal preparatory programme. Supervisors are accountable for their own development and support. However, they are advised to meet formally with a fellow supervisor at least once yearly for personal development and reflection upon their supervisory skills. Supervisors should hold a personal record of this meeting. Some Acceptable Clinical Supervision Models

• Foundation level 1:1 an initial supervision session must be obtained by everyone to ensure a basic understanding of the process, skills and knowledge required. This can be used to develop a plan of action for ongoing reflection. Following this session clinical supervision training will be provided through Learning and Development which will include practical sessions to facilitate competence.

• Reflective 1:1 supervision will involve a clinical supervisor of your choice and a framework of your choice such as Driscoll model of reflection (2007).

• Specialist Supervision for staff who are providing specialist interventions which require focussed, specialist supervision such as Cognitive Behavioural Therapy.

• Professional Supervision 1:1 supervision with an experienced practitioner in order to reflect on caseload management and treatment plans and receive coaching to improve practice and professional development

• Solution Focused Groups supervision can be obtained using the Solution-Focused Model for Reflecting Teams by Norman (2003) & O’Connell (2005). An inclusive approach should be adopted when developing group sessions including all those involved in the patient pathway including various disciplines and organisations where appropriate.

10. Monitoring Compliance and Effectiveness

Element to be monitored

The amount of supervision that is undertaken by staff at DCCG will be monitored

Lead Reports will be submitted annually to

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Quality and Safety Committee Tool

The reporting form included in this policy at appendix E will be used to collect data for monitoring purposes.

Frequency

Reporting on supervision activity is completed quarterly and a report compiled.

Reporting Arrangements

The report will be shared with the HR Governance Group, the Senior Nurse / Midwifery Committee and the Divisional Quality and Learning Group.

Acting on recommendations and lead(s)

All line managers, supervisors and the learning and development department will work collaboratively to ensure that recommendations / actions are completed in a timely manner.

Change in practice and lessons to be shared

Any changed to practice / lessons learned will be shared through Senior Nurse / Midwifery meetings, Learning and Development departmental meetings and supervisors training sessions. Where applicable email communication will also be utilised.

11. References

• Nursing and Midwifery Council (2006, page 6)

• Chartered Society of Physiotherapists (2005)

• Connor and Pokora (2007)

• Care Quality Commission

• Department of Health (1993)

• Bishop and Sweeney (2006)

• Cited in Bishop V (2007)

• Nursing and Midwifery Strategy (2013)

• Driscoll Model of Reflection (2007)

• Focused Model of Reflecting Teams by Normal (2003) and O’Connell (2005)

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SECTION C – APPENDICES Appendix A

Equality Analysis Form

Subject of equality analysis

Clinical Supervision

Type Tick

Policy �

Strategy

Business case

Commissioning service redesign

Contract / Procurement

Event / consultation

Owner Name: Suzannah Cookson Job Title: Head of Quality

Date 15.12.2015 Assessment Summary

Clinical Supervision is a process by which professionals are assisted to improve practice, develop both professionally and personally, and manage complex situations associated with the care and treatment of patients. It is a method of supporting and developing competence by providing practitioners with the opportunity to meet either on a regular or adhoc basis with an experienced colleague or peer to discuss, reflect and learn from their experiences in clinical practice.

Stakeholders

Tick Staff �

General public Service users Partners Providers Other

Data collection and consultation

Nursing and Midwifery Council (2006, page 6) Department of Health (1993) The policy has been developed by the Head of Quality / Designated Nurse for Safeguarding Children. Consultation has taken place within the Quality and Safety Team.

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Protected characteristic

Positive Neutral Negative

Negative: What are the risks?

Positive: What are the benefits / opportunities?

Age

�

The policy is accessible and is to be used by all NHS Doncaster CCG

Clinical Staff.

Disability

�

Gender

�

Race

�

Religion & Belief

�

Sexual Orientation

�

Gender reassignment

�

Pregnancy & Maternity

�

Marriage & Civil Partnership

�

Social Inclusion / Community

Cohesion

�

Conclusion & Recommendations including any resulting action plan

The policy is accessible and is to be used by all NHS Doncaster CCG Clinical Staff.

Review date December 2018

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APPENDIX B

PROCESS FOR REQUESTING INDIVIDUAL SUPERVISION

Individual identifies need

for supervision

Need for supervision is agreed between Line

Manager and Individual

Individual approaches a supervisor directly and agrees for supervision

to commence

Supervision Commences

Records of supervision

episodes are filed securely and available for audit

purposes

Records of group supervision are maintained

by the supervisor and evaluation is undertaken

as agreed

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APPENDIX C PROCESS FOR REQUESTING GROUP SUPERVISION

Individual identifies need

for supervision

Need for supervision is agreed between Line

Manager and Individual

Individual approaches a supervisor directly and agrees for supervision

to commence

Supervision Commences

Records of supervision

episodes are filed securely and available for audit

purposes

Records of group supervision are maintained

by the supervisor and evaluation is undertaken

as agreed

APPENDIX D

CLINICAL SUPERVISION CONTRACT Supervision contract agreed between: Supervisee Name:

Supervisor Name:

Supervisee Designation:

Supervisor Designation:

For the period (insert to and from dates): 1.

Identified Needs:

2. Frequency of Supervision:

3. Length of Supervision Sessions:

4. Agreed Place to Meet:

5. Record Keeping:

6. Agenda setting mechanism:

7. Confidentiality:

8. Process for resolving conflicts / issues of difference / tensions within the supervisory relationship:

9. Process for feedback to line manager (where applicable):

Supervisee Signature:

Date:

Supervisor Signature:

Date:

APPENDIX E RECORD OF SUPERVISION ACTIVITY

Name of Supervisor: Date of Activity from: to: Date of Supervision Session

Time of Supervision Session

Duration of Supervision Session

Named of Supervisee

Workplace of Supervisee

Evaluation of Supervision Process Undertaken (Y / N)

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APPENDIX F SUPERVISION RECORD

Name of Supervisor

Name of Supervisee

Date of Supervision Session

Supervisee Job Role & Workplace

Start Time

Finish Time

Session Number

Location

Agreed goals for session Summary and context of discussion Action points Reflection on original aims for supervision Supervisee feedback / comments Signature of Supervisee: Signature of Supervisor: Date:

Confidential between the supervisor and supervisee

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