Supervision has been part of occupational therapy practice in New Zealand for more than two decades. Engagement in supervision is expected by the New Zealand Association of Occupational Therapists (NZAOT, 2005) and mandated by the profession's regulatory authority, through its Code of Ethics (Occupational Therapy Board New Zealand, 2004a). However, little is known about current supervisory practices in New Zealand, or therapists' experiences of providing or receiving supervision. Even less is known about what outcomes supervision achieves. This article raises questions about the outcomes occupational therapists in this country want from supervision, arguing that a single process cannot accommodate all the differing expectations of key stakeholders. The discussion is informed by findings of a small-scale qualitative study undertaken to explore the phenomenon of supervision as it is currently implemented.
Because supervision has been incorporated into the professional, organizational and regulatory structures in New Zealand, an overview of how this happened, the various stakeholders in this country and their differing perspectives is provided. Following that, a more general discussion of local and international literature is presented to clarify the key issues.
The New Zealand context
In the health and disability sector in New Zealand today, there is a dual emphasis on ensuring organisations provide quality services that are effective and efficient, while also ensuring practitioners are competent and accountable for the quality of service they provide (Ministry of Health, 2000). The Health Practitioners Competence Assurance Act (HPCAA) 2003 addresses the latter. The Act has resulted, for occupational therapists, in greater emphasis being placed on supervision. Two mechanisms set up by the Occupational Therapy Board of New Zealand (OTBNZ), which administers the Act, have been influential.
Firstly, the HPCAA (2003) requires regulatory authorities to protect the public by ensuring registered health professionals are competent to practice. The Continuing Competence Framework for Recertification (CCFR) developed by the OTBNZ was designed to achieve this purpose, enabling therapists to demonstrate their ongoing competence for annual recertification. The framework specifies that therapists receive supervision and maintain a supervision log detailing "the nature and frequency of professional development" (OTBNZ, 2004b, p. 8). The CCFR requires identification of professional development activities undertaken to maintain competence, and makes provision for supervisors to comment on these. A declaration is required from a third party attesting to a therapist's fitness and competence to practice. This person may or may not also be a supervisor. The third party has access to supervisor comments to inform the declaration (OTBNZ, 2004b). These requirements are given further weight by the Board's Code of Ethics (2004a) which specifies that occupational therapists should "receive effective professional supervision relevant to the work setting" (p. 3).
Secondly, the HPCAA (2003) empowers regulatory authorities to require individual, or indeed all health practitioners, to undertake a competence programme "for the purpose of maintaining, examining or improving" (p. 36) competence to practice. One form such programmes might take is a period of supervised practice (HPCCA, 2003, Section 40(f), p. 37). In the context of this governmental expectation, NZAOT recommends supervision for all therapists in the belief that it "enhances professional development, clinical competence and safe practice. It reduces risk to the client and clinician" (NZAOT, 2005, p. 1).
The New Zealand occupational therapy profession's current understandings of the process and purpose of supervision has evolved over the last three decades. Based on a search of published documents and speaking with therapists who have practiced for some time, it appears that most occupational therapy departments in New Zealand had introduced supervision by the mid 1980s. …