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Gagne's 9 steps can be a useful framework - more information here
Blooms taxonomy can assist in developing learning objectives / outcomes.

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- Normative / managerial.
- Formative / educative.
- Restorative / supportive.

As a supervisor you may provide all or 1 of the above functions

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Please post your questions or thoughts in the chat and we look to support / signpost you as appropriate.

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Experiences of being a supervisor - please post in chat.

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Experiences of being a supervisor - please post in chat.

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Templates and resources that can be adapted and changed may be found on the NATH website.

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1. Nottinghamshire alliance training hub run regular supervision training (access here)
2. e-Learning for Healthcare programme - Supervision for multi-professional teams’

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How do I become a good clinical supervisor?

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How do I become a good clinical supervisor?

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Start with self-assessing and reflecting on your own knowledge and skills.

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Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Strengths and limitations of this study

This paper was based on evidence identified in the international literature using a rapid review, which involves a systematic search and rigorous analysis.

Papers were limited to Western only and the last 10 years for pragmatic reasons.

Although in many areas there was a vast amount of information, which provides strength to the findings, a rapid review necessarily pays less attention to study design and sample sizes.

Much of the data were heterogeneous in nature, and this also hindered our ability to relate the findings to specific professions and settings.

The findings drawn from the overall themes were evident across much of the literature.

Introduction

Understanding what makes clinical supervision effective and learning more about the barriers to and challenges of effective supervision are important concerns for the health and social care workforce. Most organisations provide some provision, but many lack an understanding about why it is important, who should be involved, what the possible benefits are and how it could be improved.

Supervision is at the core of practice for all health and social care professionals, where there should be a sense of shared responsibility for the effectiveness and safety of practice. 1 It is important to understand this complex process to ensure best practice for all participants involved (practitioner, service delivery manager, clinical supervisor, peers, clients and other service users, the profession itself).

Supervision has been described as an event that involves an ongoing professional relationship, between two and more staff members with different levels of knowledge or expertise, to support professional development and to enhance knowledge and skills. 2 Definitions of supervision emphasise the promotion of professional development in addition to ensuring patient safety. For example, Nancarrow et al 2 focus on the progression of clinical practice through professional guidance and support and refer to Proctor's 3 three functions of supervision-managerial/administrative, educational and supportive. All three functions should be overlapping and flexible. 2

It has been suggested that there are many forms of supervision: internal managerial, internal reflective, external professional and external personal. 1 4 At one end of this continuum, managerial supervision takes place inside the organisation and is mostly focused on task and process. At the other end, personal supervision is worker focused and centres mainly on the narrative brought into the supervision space by the worker. 1 This last type of supervision (personal) has been highly valued by workers to air their feelings; providing a safe place to connect and self-reflect. Personal supervision allowed a more intensive focus on clinical issues and personal professional development rather than organisational concerns. 4 Two types of supervision tend to coexist when the line manager is also the clinical supervisor-a focus on practitioner learning and development, and another focused on service delivery, risk management and underperformance. Kilminster and Jolly 5 argued for clarity on dealing with underperformance in addition to identifying what helps and hinders effective clinical supervision. Managing this split highlights the need for supervisor training.

In this review, we used the following definition of supervision as it encompassed both personal development and service development in the context of a relationship extending over time:

This relationship is evaluative, extends over time and has the simultaneous purposes of enhancing the professional functioning of the more junior person and monitoring the quality of the professional services. (Bernard and Goodyear, p8) 6

While it is evident that supervision is important, we must now understand exactly what aspects of supervision we should be focusing on, and it is hoped that best practice can be sought from looking across such a range of different healthcare professionals. Any critical differences that impacted on supervision across health professions were also noted.

Methods

A Rapid Evidence Assessment (REA) was used in this study. A REA is similar to a systematic review in that they both use rigorous methods of appraising and synthesising evidence from published studies. 7 However, restrictions on the data retrieved are placed on the search at the data collection phase.

Discussion

This rapid systematic review aimed to identify the enablers of and barriers to effective clinical supervision and identified the benefits of supervision for supervisees and supervisors within the workplace.

When in place and done well, clinical supervision has many benefits for the organisation, professional development and patient services, and each of these three levels makes an important contribution to ensure benefit is achieved. This review has highlighted evidence which indicates what needs to be in place to ensure clinical supervision is effective. Evidence from the literature review indicates that the organisation plays a key role in ensuring supervision takes place, 60 95 102 that it is valued and expected, 73 95 that supervisors are trained 29 37 68 79 91 99 104 121 and time is protected. 22 25 79 92 99 122 Supervision needs to be provided in a neutral, open, supportive environment to facilitate discussion and reflection on clinical practice, career development and any personal issues that may arise in the workplace. 4 9 10 13-16 18 20 21 23-26 29 30 32-34 44 117 123-125

Having a relationship based on trust with the supervisor was also found to be key. 2 4 10 11 28 32 39 42-46 There was also evidence on the benefit of reflecting on practice 18 28 and on receiving feedback. 30 40 41 Having regular but flexible supervision that fitted around all stakeholders' needs was also highlighted as important. Clinical supervision provides the chance to facilitate learning opportunities when needed 98 and to upskill staff who were underperforming. 110

There was much evidence about the positive benefits of clinical supervision, in that those who received support through clinical supervision were better able to cope with the demands of the job 23 75 and were less likely to leave. 69 126 Effective supervision increased resilience 78 and job satisfaction. 68 69 127 There was also evidence to suggest that supervision helped with reducing stress and anxiety. 63 Supervision was also seen to drive up the quality of care and has a positive effect on the working environment. 16 23 71 77 80-82 87

A number of barriers were highlighted within the literature that should be taken into consideration when exploring how to implement effective supervision practice. These included a lack of time and heavy workload, 2 16 17 21 35 41 48 54 57 64 73 83-85 87-96 98 a lack of resources, 18 37 60 unsupportive management and colleagues, 2 27 31 73 93 102 128 a lack of supervisor training, 11 17 32 38 64 76 91 92 105-107 124 and a lack of trusting relationships and ongoing support. 16 17 45 61 75 84 117 118 Supervisees were also sometimes unaware of the purpose of the supervision practice, 2 60 64 100 119 impacting on engagement. 2 A recent study has highlighted the need for supervision to include patient care, concluding that the usual model of meeting for a supervisory discussion away from patient care was not found to be effective. 129 Although this is an interesting and important finding, our findings would suggest that the overall supervisory experience is not as simplistic as this. There is a need to take into account all of the factors and levels presented in this paper, there being no single answer leading to effective supervision.

There were no critical differences identified across the range of healthcare professionals in terms of ensuring effective supervision is in place, with similar themes being apparent across all. Naturally, professions such as psychologists and social workers will face different challenges and have different needs from their supervisory relationship; however, this is part of the supervisory process and identification of those needs is what will make it an effective experience for the supervisee.

It is clear from the evidence that support from management is needed to enable effective implementation, including cost and training for staff. However, this review has highlighted that supervision is subject to different interpretations by managers, who tend to focus more on service delivery rather than on staff development, and agreeing on the shared purpose of supervision is important to reduce ambiguity. 1 10 Beddoe 1 argued that managerial supervision creates a shift from being practitioner focused to a monitoring agenda. Problems seem to arise when the focus was perceived to be monitoring performance, rather than on the provision of support. 1 9 10 39 42 115 Pack 72 highlights that line managers need to focus on protecting the employing organisation and their patients/clients from risk, 96 whereas external supervisors can focus more on the personal development. This split may offer a solution that avoids the inevitable tension experienced by a manager who is also the clinical supervisor. The issue of managing underperformance alongside personal development further highlights this tension and indicates again that having two different supervisors might offer a solution; like experienced by junior doctors in the UK, who have an educational supervisor (who overseas educational development) and a clinical supervisor (who overseas clinical practice). A split role, when feasible, might be the preferred solution and when this is not an option then supervisors need training to support them to manage these challenges. The model of practice which is best is a source of continued debate. However, what is clear is that there is no 'one size fits all' for clinical supervision and all stakeholders need to consider how to make their supervision as effective as it can be and involve discussion to agree on the shared purpose of clinical supervision.

Conclusions

This review has identified the following enablers of and barriers to effective clinical supervision with regard to the organisation, the supervisor and supervisee.

Enablers included having a set place and a regular time slot for supervision to ensure it takes place. It is more likely to occur when a private space is made available and when protected time is available. Also, there needs to be some flexibility to enable staff working irregular hours such as night shift to access clinical supervision. Barriers to supervision happening were apparent when these issues of place and time were not in place.

Another key enabler identified was when the supervisory relationship was based on a positive relationship and on mutual trust. Ideally, supervisees should be offered a choice of supervisor and there should be some cultural understanding between them. When this is not the case, when the relationship lacks trust, this becomes a barrier, as does having to accept a supervisor not well matched to the supervisee and when cultural understanding is missing.

For clinical supervision to be effective, there needs to be a shared understanding of its purpose. Ideally, this is based on the individual needs of the supervisee and the focus is on enhancing knowledge and skills to support professional development and improve the service. Barriers occur when there is no agreed purpose and no agreement or conflicting views on the focus of clinical supervision.

This review identified that a range of types of supervision can be effective: one-to-one, group, internal, external and distance supervision can all offer a range of benefits. Going forward, having different types of supervision, with different people who offer different perspectives, should be considered and may overcome some of the barriers in place when only one, poorly matched, supervisor is available. Clearly, having different supervisors also overcomes the problem of having a line manager who is both the clinical supervisor and service manager and who may need to manage the needs of the service with the potentially conflicting needs to the individual. Lastly, providing training to supervisors is helpful to ensure they are supported and developed in this role and indeed also benefit from feedback themselves, without such training barriers to effective supervision may occur.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

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Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review

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Objectives We aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision. Design A rapid evidence review. Data sources Five databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals.

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Supervision - it's about checking in, not checking up

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1. Supports professional practice and reflection
2. Supports continuing professional development
3. Improves patient outcomes
4. Improves wellbeing
5. Improves workplace environment and culture

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According to NHS England’s Core Supervision Model for Multi-Professional Teams published on Future NHS Collaboration Platform in July 2020, supervision aims to safeguard standards, develop professional expertise, and support delivery of quality care.

It is a formal process of:
- professional support and learning,
- identifying solutions to problems,
- encouraging self-assessment and reflective skills,
- encouraging staff to view patients / clients as individuals
- supporting clinicians to explore their feelings
- providing a link between research and practice.