Rethinking Professional Education and Development

1
Rethinking Professional Education and Development

• Clinical Supervision
• Factors influencing practice
• Dr Sarah Newton
• Plymouth Teaching Primary Care Trust
• 9th October 2007

2
Clinical Supervision Factors influencing
practiceTheoretical cycle of learning and
practice
3
Clinical Supervision Factors influencing
practicePrevious work

• Learning and putting into practice is a complex
  relationship (Fish and Twinn, 1997)
• Complexity increases as do the number of
  influential factors (Ellis Ladany, 1997
  Goodyear and Bernard, 1998 Davy, 2002)

4
Clinical Supervision Factors influencing
practiceWhat is Clinical Supervision?

•  
• An exchange between practicing professionals to
  enable the development of professionals skills,
  an opportunity to sustain and develop
  professional practice
• Faugier and Butterworth 1994.

5
Clinical Supervision Factors influencing
practiceWhat is Clinical Supervision?

• It is distinct from line and caseload
  management, professional leadership and personal
  therapy, although there are some commonalities
  with these and pre post qualification
  training/learning frameworks such as placement
  supervision, mentorship, preceptorship etc.

6
Clinical Supervision Factors influencing
practiceWhat is Clinical Supervision?

• Essentially engagement in the practice of
  clinical supervision not only improves
  professional practice and effectiveness but also
  attends to the impact of the work on the staff
  member. It therefore has the potential to nurture
  and sustain personal wellbeing in professional
  practice.

7
Clinical Supervision Factors influencing
practiceInskipp and Proctors (1993) Model of
Supervision
Clinical Supervision
8
Clinical Supervision Factors influencing
practiceWhat are the Factors?

• Individual (needs (identified), perceived
  relevance, motivation, personal circumstances,
  pay)
• Organisational support for learning (funding,
  time away from usual duties, additional
  resources)
• Organisational support for practice (time, place,
  resources, culture, context)
• Multi professional learning and working
• Partnership working across organisations

9
Clinical Supervision Factors influencing
practiceWhy the focus on clinical supervision in
PtPCT?

• Enabling Excellence quality improvement programme
• Why was clinical supervision not taking place?
  (audits 2002 2005)
• Some training had taken place-generic and models
  of supervision based on psychological models for
  therapies
• Few areas of practice had developed
• Not always routinely and regularly practiced
• Practiced in wrong places at wrong times
• Professional differences and barriers
• Individual factors confidence, motivation, poor
  understanding of potential personal benefits
• No whole organisation approach
• Focus on performance targets and away from staff
  wellbeing, despite Improving Working Lives
  initiatives

10
Clinical Supervision Factors influencing
practiceClinical Supervision Steering Group
11
Clinical Supervision Factors influencing
practiceModel to sustain practice
Lead reports to Clinical Supervision Steering
Group
12
Clinical Supervision Factors influencing
practiceResources developed by the Clinical
Supervision Steering Group

• Coordinator of Clinical Supervision
• Clinical Supervision Policy
• Clinical Supervision Contract Paperwork
• Training- one day courses from February 2006
• Foundation Training for Supervisees
• Supervisor training
• Course materials
• curriculum, handouts, pre-course self assessment,
  DVD (Actor Factor)
• Toolkit
• Audits of course attendees and managers of
  services and professions 2007

13
Clinical Supervision Factors influencing
practiceFunding sources

• Workforce Development Confederation Strategic
  Health Authority funding for Coordinator
  (32,000)
• KESW funding (11,250) for training on the basis
  of funding provided by the PtPCT (20,250)
• Knowledge Exploitation South West
• KESW funding to extend training
• Senior personnel time - Plymouth teaching PCT,
  University of Plymouth and University College
  Plymouth St Mark and St John
• Professional and managerial time Staff of PtPCT

14
Clinical Supervision Factors influencing
practiceMaking the learning and practice
relevant and appealing

• Agenda for Change
• Job Profile Factors
• Knowledge and Skills Framework KSFC1
  communication, C2 personal and people development
  C3 health and safety, C4 service improvement, C5
  quality, C6 diversity G1 learning and
  development, G6 people management
• Appraisal
• Opportunities
• for further studies in partnership courses with
  accreditation
• Standards for Better Health
• Second domain-clinical and cost effectiveness
• Ethos
• aim for highest standards for engagement in and
  practice of clinical supervision whether Trust
  Policy or Professional guidance

15
Clinical Supervision Factors influencing
practiceAudit of course attendees and their
subsequent practice

• Since February 2006
• 381 attended Foundation day
• 179 attended Supervisor day
• 90 attended both courses
• 419 audit questionnaires sent out September 2007
• To date 76 returned completed (18)

16
Clinical Supervision Factors influencing
practiceAudit of course attendees and their
subsequent practice

• 57/76 are actively receiving supervision
• Majority in individual supervision, others in
  group supervision
• Majority in monthly one hour supervision sessions
  and happy with this
• Most in PtPCT time and on PtPCT property and
  linking with Appraisal process, KSF, Personal
  Development plan and CPD logs
• 40/76 active as supervisors
• Each supervise 1-11 members of staff

17
Clinical Supervision Factors influencing
practiceAudit of course attendees and their
subsequent practice

• Majority have read the policy
• Just over half supervisees and half supervisors
  have written contracts for supervision
• 21/59 noted practical concerns about time

18
Clinical Supervision Factors influencing
practiceAudit of managers of services and
professions

• 151 questionnaires sent to managers and
  professional leads in September 2007
• 16 responses to date
• 17 service areas represented
• 192 staff commented on (124 qualified)
• 79/192 staff receiving supervision (60 qualified)
• Majority in 4-6 weekly supervision

19
Clinical Supervision Factors influencing
practiceAudit of managers of services and
professions

• 45 staff providing clinical supervision
• 54/122 job descriptions mention need for
  supervision
• 12/17 managers and professional leads referred to
  supervision in appraisal
• Some noticeable changes in motivation, role
  clarity, team working, sickness levels

20
Clinical Supervision Factors influencing
practiceQuestions arising from the audit
information

• What about the staff and managers/leads who have
  not repliedare they engaging in practice or not?
• How does this data relate to the course
  evaluation comments? (work to be completed)

21
Clinical Supervision Factors influencing
practiceChallenges ahead

• Continuing training through opening up to other
  organisations with paid places
• Partnership course with the University of
  Plymouth for supervisors
• Toolkit publication for self-learning and as a
  reference source
• Continuing the work through ensuring integration
  with continuing changes and priorities in the NHS
  and PtPCT

22
Clinical Supervision Factors influencing
practiceConclusions

• Working relationships within and activities of
  the CSSG have
• Driven the outcomes achieved
• Fostered creative solutions to potential and
  actual barriers and challenges
• Configuration of the CSSG has been mirrored in
  all subsequent activities and outputs
• multi-professional
• cross-organisational support and endorsement
• Transformations from learning to practice in the
  CSSG are beginning to be evidenced within the
  workforce of the PtPCT

23
Clinical Supervision Factors influencing
practiceConclusions

• Multi-professional learning and working is here
  to stay and can open new options and
  possibilities that enable more people to benefit
  from activities
• Partnership working across organisations can be
  powerful and enrich the work achieved perhaps
  more than would be possible in one organisation
  alone

24
Clinical Supervision Factors influencing practice
25
Thanks to

• Ruth Clemow, Associate Dean (Learning and
  Teaching), Plymouth University
• Maggie Cooper, Dean of Health, University College
  Plymouth St Mark and St John
• Hazel Bending, Lecturer, University College
  Plymouth St Mark and St John
• Members of the Clinical Supervision Steering
  Group
• Mary McClarey, Head of Clinical Effectiveness and
  Research Steve Waite, Director of Operations,
  Plymouth teaching Primary Care Trust
• Clare Frampton and Leanne Walker Clinical
  Psychology Services Plymouth teaching Primary
  Care Trust

26
Clinical Supervision Factors influencing
practiceReferences

• Butterworth, T. and Faugier, J. (Eds) (1999).
  Clinical Supervision and mentorship in nursing.
  London Chapman and Hall.
• Davy, J. (2002). Discursive reflections on a
  research agenda for clinical supervision.
  Psychology and Psychotherapy, 75, pp221-238.
• Department for Health (July 2004, updated April
  2006). Standards for Better Health. London
  Department for Health.

27
Clinical Supervision Factors influencing
practiceReferences

• Ellis, M. V. and Ladany, N. (1997). Inferences
  concerning supervisees and clients in clinical
  supervision an integrative review. In C. E.
  Watkins, Jr. (Ed.) Handbook of psychotherapy
  supervision. New York Wiley.
• Fish, D. and Twinn,S. (1997). Considering
  competencies and assessing professional
  competence in practice. Chapter 7, pp 142-163 in
  Quality clinical supervision in the health care
  professions. Edinburgh Butterworth Heinemann.
•  
• Goodyear, R.K. and Bernard, J. M. (1998).
  Clinical Supervision Lessons from the
  literature. Counselor Education and Supervision,
  38, pp6-23.
• Inskipp, F. Proctor, B. (1993). The art, craft
  and tasks of counselling supervision. Part 1.
  Making the most of supervision. Twickenham
  Cascade Publications