Overcoming barriers to supervision

Ensure leadership awareness of:

• employer responsibilities for supervision as part of workforce governance
• links between supervision and both professional and public safety
• relationships between professional/public safety and headline national metrics such as recruitment and retention and the links between staff vacancy rates, sickness absence and clinical productivity

Supervisor training and development:

• ensuring the provision of high-quality supervision is factored into workforce development strategy and business planning
• where workforce initiatives seek to develop advanced clinical practice using the integrated degree apprenticeship route, ensure the workforce planning has taken account of employer responsibilities set out in the degree apprenticeship standard
• including the provision of training and development in supervision as part of workforce development strategy
• having monitoring processes to ensure supervision training and development is undertaken and updated
• agreeing a ratio of trained supervisors to clinical staff which will ensure professional and public safety while optimising clinical productivity

Additional resourcing:

• ring-fencing of additional resources which may be offered in-year and developing a plan around the use of these funds, e.g. where Health Education England regions may provide funding to support advanced clinical practice development/trainee supervision

In addition to ‘Supervisor training and development’ and ‘Additional resourcing’ (as above) Supervisor training/ development and support with a focus on advanced clinical practice:

• Developing or accessing supervisor development opportunities which specifically include content with a focus on multi-professional supervision and on advanced clinical practice (levels and roles) as detailed in appendix 6
• Reviewing existing supervisor development and training to adapt or augment to include multi- professional supervision and on advanced clinical practice (levels and roles) as detailed in appendix 6
• Establish networks, learning sets, peer support for supervisors providing supervision in the multi-professional advanced clinical practice context

In addition to the above:

• Establish/ nominate an ‘Advanced clinical practice lead’ within the organisation; agree the scope of this lead role in terms of strategy including workforce development and governance
• Provide wider awareness-raising opportunities for the organisation and within teams regarding the potential value of advanced clinical practice
• Ensure a focus on practice demands and patient needs rather than uni-professional starting points in training, development and awareness raising activities
• Share advanced clinical practice exemplars within and beyond the immediate practice setting/provider, including examples of impact examples of impact on headline metrics such as length of stay, patient satisfaction, reduced waiting times
• Encourage small scale quality improvement projects and/or audits to evaluate impact or potential impact of advanced clinical practice on headline metrics; recruitment and retention, length of stay, waiting times, pressure care and so on
• Direct key clinical and operational leaders to access national and regional Health Education England advanced clinical practice resources via the Advanced clinical practice toolkit
• Encourage key clinical and operational leaders to engage in and attend national and local events which focus on/showcase advanced clinical initiatives
• Develop local advanced clinical practice ‘special interest group’ / forums/ journal clubs (actual or virtual)

in addition to the above:

• Provide comprehensive training/development opportunities and updates for those delivering supervision across professions in the context of advanced clinical practice.
• Ensure training and development includes attention to scope of practice for different professional registrations
• Have local policy for the development of advanced clinical practice which clearly sets out lines of clinical and managerial responsibilities and accountability.
• Ensure local policy provides guidance for resolving clinical or wider professional/ practice concerns where the boundary may blur between line management, clinical practice, academic progress and so on

Collaborative approaches:

• Using mechanisms such as training hubs and STP/ICS networks to pool supervision resources and ensure spread of supervision expertise/experience
• Consider innovative and digital solutions including video-conferencing supervision, e.g. South Yorkshire and Bassetlaw ECHO
• Include the identification of space for supervision at a planning stage
• Identifying and booking space where feasible in advance of a scheduled supervision session
• Supervisor and supervisee agreeing within the supervision agreement what constitutes a suitable physical space for supervision to take place.

Supervisee suspicion about purpose of supervision:

• Concerns about surveillance
• Perceptions based on previous unsatisfactory supervision experiences

Professional registration responsibilities:

• Awareness refreshers for health profession registrants about their professional responsibilities to engage in supervision
• Awareness refresher regarding the relationship between supervision and both professional and public safety
• Additional professional development possibilities
• Opportunities which include the development of ‘permeable’ behaviours and characteristics (see appendix 4)
• Ensuring matching of supervisors to supervisees maintains a practice demands and specified capability/ competency focus rather than a professions’ focus

See earlier possible solutions which encourage the development of:

• Awareness of the links between supervision and professional/public safety.
• Learning and development opportunities which highlight the inter- professional duty of care between one professional and another

See earlier possible solutions which include:

• Training which includes awareness of variations in scope of practice for different registered professions
• Supervisor development which has a practice demand, capability and competency focus rather than a professional focus

Additional professional development possibilities which include:

• Supervisor development which includes exploration of communication skills, approaches to feedback provision, negotiation and conflict resolution
• Agreeing at the outset of supervision how conflicts will be resolved
• Regular evaluation of supervision effectiveness and satisfaction