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Supervision practice in health Essay

1.1 – Supervision is a process in which the employee is given the opportunity to meet with an appropriate senior staff member (this would be someone who has received the correct training and has gained knowledge and experience in carrying out an successful/meaningful supervision) to enable both parties to reflect on working practice usually through observations, reports and discussions to name a few. I have noticed while doing supervisions that it is easy for the employees to develop a culture of becoming nervous/anxious at impending supervisions thinking that they will be told about poor working practices/ performance. So it is vitally important that employees understand supervisions are to give feedback on both sides and are to be viewed as a positive experience, indeed a purposeful supervision should leave staff feeling valued and respected as well as giving them opportunities to discuss training needs, develop their knowledge and skills, ensuring their understanding of accountability and maintain professional standards, you give positive and productive feedback.

Morrison’s (2005) Suggests there should be underpinning beliefs to supervision, some of which are: high standards, reflection as well as action, include both process and content and supervisors should be role models. Morrison also goes on to describe the scope of supervision as a process involving complex relationships between the supervisor, the supervisee, the organization and the service users. In short I think supervision is to address the need to develop knowledge and skills and the importance of developing and maintaining a quality service. Also covering the need to ensure professional standards are maintained, policies and procedures are understood and correctly carried out and staff are given the opportunities to learn through reflective practice and experience.

Supervision and its aims also come in the form of: Team meetings-these are held on a monthly basis, all staff are made aware of the upcoming date of the meeting and are encouraged to write down any work related topics for discussion on the agenda before hand, then the aim of the meeting should be to solve issues, impart information, update working practice and hopefully engage staff in positive outlook to their work. Appraisals-these are done on an annual basis. Staff would be given a questionnaire to complete and hand in beforehand, these are evaluating staffs and managements performance, this would then be discussed in a safe confidential environment where discussions take place over future goals, staffs development and previous appraisals.

1.2 – Davys and Beddoe’s (2010) supervision model integrates management and development and uses a triangle with each point having a supervisor function. 1) Managing service delivery, 2) facilitating professional development, 3) focusing on practioner’s work. These 3 points are all linked by the sides that manage the tension, surrounding the centre of support. The stoltenburg & delworth model 1998 seems to council staff in a more holistic way based on their current developmental level, as this model is able to break down the categories, autonomy, self and other awareness and motivation into levels that can accurately identify the supervisee’s currant stage of development while at the same time assisting in their advancement to the next stage.

The care quality commission brought out guidance on clinical supervision after the winterbourne review, named “supporting information and guidance: supporting effective clinical supervision” the aim of this supervision is that its specifically developed for doctors, nurses, social workers and health care workers. And not only does it provide support for staff in reflective practice, discussions in changing and modifying practice and personal and professional development it also focuses on how to manage the personal and emotional impact of their practice. This is particularly important for those who work with people who have challenging and complex needs. We do not use one specific model with in my own work setting, but have taken parts of many models to mould in to a supervision which falls in with our particular home.

1.3 The care quality commission – Essential standards of quality and safety (March 2010) gives us guidance about compliance in accordance with section 20 regulations of the health and social care act 2008. In outcome 14: Supporting workers it states (amongst other statements) that staff must receive the appropriate training, professional development, supervision and appraisal and be enabled to obtain further qualifications appropriate to the work they perform. So as such when Staff commence employment at the home it is essential they are given the correct training and guidance, we achieve this through an intensive induction which includes training on the 8 common induction standards as well as mandatory: health and safety, moving and handling, safe guarding, , whistle blowing, food hygiene and infection control.

They would also be assigned a mentor, this would be a member of staff who had completed all the relevant training, had gained experience and knowledge in the job role and was generally a good role model. New staff would shadow their mentor for several weeks and they would be on hand for advice and support. The general social care council codes of practice for employers of social care workers state in code 3 As a social care employers you must provide training and development opportunities to enable social care workers to strengthen and develop their skills and knowledge. Well this is achieved through the supervisions, appraisals, team meetings, mentoring and induction as previously mentioned.

1.4 – All findings, recommendations, reviews and recommendations are scrutinized and hopefully policies procedures and good working practiced is developed to avoid making the same mistakes. Marsh and Fisher 2005 state there are 6 main reasons evidence is needed from research within in the knowledge base of social care. Then a frame work can be developed for research and hopefully a comparison can be made between social care and primary care.

Very recently new procedures/ guidelines have been brought in due to past inquiries and reviews, these include the mum test where we ask ourselves is this service good enough for my mum to use, this is mentioned in the new amended CQC provider handbook that is coming into force in April 2015. Also mentioned in this document is the new 5 key questions we have to ask ourselves, which are – are they safe/effective/caring/responsive/well led? It is essential; all this information is imparted to staff on the front line and will be done so by supervisions, induction, mentoring, appraisals, team meetings and training.

1.5 – “Supervision must enable and support workers to build effective professional Relationships, develop good practice, and exercise both professional judgment and Discretion in decision-making. For supervision to be effective it needs to combine a Performance management approach with a dynamic, empowering and enabling Supervisory relationship. Supervision should improve the quality of practice, support the Development of integrated working and ensure continuing professional development. Supervision should contribute to the development of a learning culture by promoting an Approach that develops the confidence and competence of managers in their Supervision skills. It is therefore at the core of individual and group continuing professional development”, (Skills for Care 2007). Simply put supervisions are a really good communication tool between the supervisor, supervisee and manager.

When planning a supervision staff should receive prior notice of the supervision date so as to have the opportunity to gather thoughts questions etc, I would evidence this by logging it in the works diary. Ensure the supervision takes place in a private relaxed environment where no interruptions would take place. I usually start supervisions going over staffs individual duties and responsibilities, providing the opportunity for them and myself to discuss any issues, if they are coping with the work load, conducting them in a professional manner, and have a good/increasing knowledge of the job. If done correctly staff have on record any issues which need dealing with and the supervisor would also have recorded the advice, praise, support offered and the manager would have a good auditing tool to act on.

Next we would discuss any recommendations actions from the last supervision, to ensure the right support was being given and all had been acted on in a way as to satisfy the supervisor and supervisee, and once recorded this would be evidence supervisions were being carried out correctly. Training needs/requests would be discussed next and this would give us both a chance to discuss progression any areas needing extra support and any skills and competence that would benefit service users and the home. We do have questions in supervision that gives us the opportunity to discuss relationships within the team and also with service users. This is an area where staff need to feel secure and safe with you and hopefully you will have a good rapport which would aid in honest and more frank answers.

We would discuss key worker duties if applicable and then we ask what’s been enjoyable this month and not so enjoyable this month promoting the opportunity to feel free to express negative opinions and also promote positive feedback. Then we give the supervisee the opportunity to improve practice and have input on what areas they would like to develop and do more of whilst being offered advice and ideas from the supervisor hopefully achieving a feeling of empowerment and their views being valued and respected. We have a section where staff may raise any complaints or health and safety concerns and obviously these would need to be addressed swiftly, in a professional manner.

Towards the end we would offer positive feedback , reflect on what had been achieved, and come to an agreement on actions to be taken before the next session, for example I would put 1) induction standards need t o be completed in the next 2 weeks. 2) I would give you a date to attend your first aid course within the next week. 3) I will report the loose kitchen tiles to maintenance ASAP. The supervisee would then read everything the supervisor had wrote and if in agreement both would sign. The staff member would be offered their own copy if they wished and the original supervision would be placed in the staffs file. The staff would then know at the end of supervision what they are accountable for, have the correct tools in place to enable progression and feel supported, and are aware of what the supervisor expects of them and achieving a service that is managed effectively.

Outcome 2

2.1 – Performance management is what an organisation does to realise its potential against performance targets, to deliver high-quality services and to identify opportunities for improvement, change and innovation. Performance management systems are designed to get the best out of people in the workplace, and to deliver the best for people who use services. core social care values of respect, locating people who use services at the centre of the business model. Approached in this way, performance management can promote excellence in service delivery and result in a more highly motivated and involved workforce. Performance management involves much more than just assigning ratings. It is a continuous cycle that involves: Planning – work in advance so that expectations and goals can be set; Monitoring – progress and performance continually;

Developing – the employee’s ability to perform through training and Feedback; Rating – periodically to summarize performance and, Rewarding – good performance.

Information obtained from the scie website.

2.2 – Professional supervision is a positive and enabling process that offers the opportunity to bring an employee and a skilled supervisor together to reflect on work practice. It is the process by which a worker can review and evaluate their work through discussion, report and observation with another worker. Supervision aims to identify solutions to problems, improve practice and increase understanding of professional and clinical issues. It supports staff performance by hopefully improving working practice and therefore the service user receives a good quality service. It can develop a greater degree of self-awareness, autonomy and self esteem for staff and in turn the service user, and also develop potential, improve competency, improve communication and boost morale encouraging the growth and development of good ideas and practice.

2.3 – Performance Indicators can be defined as measures that provide managers with the most important performance information to enable them to understand the performance level of the organization they should clearly link to the strategic objectives of the home and therefore help monitor the execution of the homes objections. This usually requires some form of measuring standards or quality indicator and the information gathered from these sources can be used in staff meetings, appraisals, supervisions ETC. It has been discussed by managers that too many measures/indicators can prevent them from dealing with real improvements. (NHS IIIC, 2008) The most common type of performance indicators are: Time-speed of response, service, delivery times. Reaction-customer satisfaction, judgments by colleagues. Impact-standards, behavior, completion of work objectives. Output- case loads.


Outcome 3
3.1- Richmonds 2009 view is that supervisory relationships are imbued with power sources that emerge from both managerial and professional authority. Thus both parties to supervision will have personal experiences and beliefs that will impact on their relationship. Davys and Beddoe 2010 state power imbalances are likely to emerge from three sources. 1. The legitimate role of the line manager as supervisor. 2. The authority derived from professional knowledge and skill. 3. The perceived personal attributes of the supervisor to exercise their authority in issues of unsafe practice. 3.2 – As the deputy manager I am already in a position of power. There are two main types of power, personal (this refers to the knowledge, skills, and competence associated with an individual which makes them an expert.

As an expert the individual can exert a certain amount of power in various situations, as in the teacher- learner relationship) and organisational (this can be one of four types, reward power as in pay, promotion, or praise. Coercive is a negative form of the above-punishment, disciplinary procedures, legitimate power when the incumbent has authority, information power-has special knowledge which is valued by other staff or supervisees.

To address-build a rapport with all supervisees to establish good working relationships and set boundaries, have a clear set of expectations and clarify with each supervisee.Check regularly to see how they are doing. Give regular feedback to all. Set goals and objectives for all supervisees and agreed targets and offer support. Set tasks to match their skills. The success of the relationship depends on both parties having an open and respectful approach that enables honest disclosure of difficult practice issues. The onus therefore lies with the supervisor to use that power imbalance wisely and ethically.

Raven 1993 Hughes and Pengally 1997.

3.3- Before starting supervisions with new staff they are asked to read the company supervision policy where I will ensure they understand how supervisions work, what their rights are regarding supervisions/appraisals ETC and what they can expect from a supervision, I would also encourage questions and suggestions on this subject. If I had completed previous supervisions with staff, I would be reviewing notes and targets from those meetings to see if they had followed through with those actions and think about what needed to be brought up and discussed. They then are asked to sign a supervision contract which confirms again what they can expect from a supervision including; creating and agreeing to a safe positive culture and climate which allows the supervision be: person centered, based on an agreed agenda, private, ethical, a free flow of information and recorded. The contract would also include: Responses and measures of working with service users.

key worker involvement and working with placement plans
the staffs role in fulfilling the care homes statement of purpose degree of personnel involvement, feelings concerns and stress development and training
setting and maintenance of standards
feedback on performance
Guidance on current and new tasks
any other appropriate business
Frequency and location of supervisions.

My company recommends six per year but supervisees can request them before the agreed dates if required. 3.4- refer to 3.3

3.5- It is the general consensus that the focus of any supervision should be person centered. The evidence that may be used to inform practice may come from several sources, but should be linked to the supervisees practice objectives such as, work load management, reflection on and in practice, performance measurements and observation of practice. 3.6- refer to 3.3

Outcome 4
4.1- refer to 1.5, 2.1, 2.2, 3.2, 3.3
4.2- refer to 1.5, 2.1, 2.2
4.3- Feedback for performance is an essential part of any company’s business plan. Supervisees need to be made aware of areas in which they can improve without feeling criticized and attacked. Feedback can often put people on edge, especially in a workplace environment where personalities vary wildly and no two techniques will work identically on two different individuals. Approaching feedback appropriately will limit potentially negative impact while still creating an environment where growth and morale can stay steady. Feedback should be used to foster an environment of improvement, not to demoralize or criticize a staff. It allows them to feel connected to management while not feeling like they’re out on a ledge by themselves. When feedback is necessary, it should be approached in a positive way.

Avoid being vague or making sweeping generalizations. Instead of addressing issues that usually” happen or a situation that is always repeated, stick to specifics so the supervisee can firmly grasp the situation at hand. Once I feel the situation has been addressed appropriately, it is equally important to give that supervisee a chance to speak. I should be interested in their point of view and they can often bring up valid points that may have not been considered. If it seems unlikely they will offer feedback, asking them a question can be an effective tool to continuing communication. Once we both have had a chance to speak, it’s time to act as a supervisor without having to come down hard or criticize your staff’s behaviour or actions.

Offer alternatives to the way that each specific situation could have been handled and encourage discussion of the options. This way they get the sense that you’re not there to “get them in trouble” but rather to help them improve in the future. This also lets them realize that you’ve put thought into this situation specifically and you’re interested in creating a better work environment for your team. Shohet 2006 provides a useful acronym for giving effective feedback: CORBS, which stands for; Clear – what and why. Owned – use “I” statements. Regular- frequent. Balanced – confirming, corrective and reflective. Specific –related to an event or behaviour.

4.4- Refer to 1.2, 1.5, 2.2

4.5- Before starting each supervision I will check to see what previous targets and goals have been set then discuss them in the supervision, I check to see if they are having any problems, if they are achievable, and if they are happy with them. At the end of every supervision we set the new targets, weather that is to continue towards achieving the one s that are already set, or completing training or even follow care plans more accurately to name a few. Once again I check to see if they think these are achievable and they are happy with them, and what help they think they need to achieve them. The supervisee then reads the supervision form where I have made notes 4.6- It is accepted that practitioners in health and social care settings can be affected by the stressful nature of the work. (Godden 2012)

When discussing challenging situations with supervisees we need to ensure they feel supported and have received the necessary training such as DMI and have completed their induction. Ensure they understand they have to adhere to the behaviour management programs and relevant risk assessments. If a specific incident has occurred reflect with them the effects of events and consequences and actions that occurred, using the records of incidents, A B Cs and tick charts for reference if needed. Help them to understand how they might have caused and influenced events and work out the most effective way to handle the situation.

4.7- refer to 4.5

Outcome 5

5.1- Senior staff A had a had an approaching supervision and I had noticed recently that I had had to approach her on numerous occasions about not following service user b’s care plan correctly in supporting and encouraging their independence. I discussed this problem with my manager who also informed me she had spoken to her about similar occurrences. Before commencing the supervision I made notes of these occasions and also wrote recorded positive practice to relay back to her. I started the supervision off with positive feedback, saying how I impressed I am with how she carry’s out personal care in such a way that protects the individuals dignity and put them at ease, she seemed really pleased with these comments. I then expressed my concern over the fact that I think that sometimes struggle you promote independence as well as you promotes dignity. Senior staff A then questioned why I thought this so I asked her to reflect on why she thought I would say that. She then stated “is it because I go into the bathroom with service user b to assist with personal care, instead of standing outside the bathroom door?”

I confirmed it was. She then expressed concern that she doesn’t agree with this in case they get in the bath and it’s too hot. I explained that risk of that happening was extremely low otherwise we would not allow it, also water temperatures were monitored, it was correctly risk assessed and service user b had the ability to regulate hot and cold water. She then went on to say that where she used to work that it would not have been allowed. I then asked her if she really thought I would put the service user at risk in any way. She said no of course not, if was just had for her to get used to allowing service users so much independence. I then went on to explain that as a senior she must realize that if staff see her not following care plans they could possibly do the same causing the loss of continuity of care, she stated she understood.

I conceded that if she thought the water was going to be a concern then take the temperature quickly before the service user gets in, then leave the bathroom again. I then went on to explain that if she thinks a care plan isn’t working she must communicate it to management so we can implement changes or explain the reason why it is done in a certain way. She said that she would and assured me she understood the reasons. I felt I may have become a little defensive because I wrote the care plan and probably should have been a bit more detached. I also didn’t want senior staff A to feel like her opinion didn’t matter and that management didn’t take any notice of concerns raised, but at the same time I needed her to understand that at a senior level especially, it is essential to be seen following care plans and communicating changes 5.2-refer to 5.1

Outcome 6
6.1- see attached paper work

6.2- Before evaluating feedback I do think there are several areas I need to concentrate on improving so as to allow my supervisions to work more effectively. Which are; time constraints, managing my time better to allow me to be more accessible, and also ensuring supervisions are not cancelled through sickness, staff shortages ETC. I also need to improve my skills to allow staff to be more reflective about their practice, encourage them to find answers to their own questions and improve knowledge. After reading feedback I find I need to motivate staff better, and feel I could do this by encouraging personal growth, offering more individual personalized training, and remind them of promotional opportunities. I also could make them feel more empowered, assure them how we trust their judgment and how opinions ideas are important, listened to and appreciated.

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