The MCSS-26©: Revision of the Manchester Clinical Supervision Scale© Using the Rasch Measurement Model

Article excerpt

Background: Previously published accounts of the evaluation of the effects of clinical supervision, a structured system to support health service staff, have been mainly contained to small scale qualitative studies. Over the past decade, the 36-item Manchester Clinical Supervision Scale (MCSS) has transformed the evalua tion landscape and has been used as a quantitative outcome measure in upward of 90 licensed studies in 12 countries worldwide. The factor structure has been replicated by other researchers and the psychometric properties have been found robust. However, it had not been previously tested empirically using newly available and sophisticated statistical analyses. Purpose: This study tested the original factor structure and response format of the MCSS for goodness of fit to the Rasch model, using Rasch Unidimensional Measurement Model (RUMM) 2030 software, and investigated the validity of the questionnaire for both nursing and allied health (AH) staff. Methods: A series of Rasch analyses were conducted on the seven subscales of the MCSS. The default procedure for RUMM software uses the partial credit model, which allows items to have varying numbers of response categories and does not assume the distance between response thresholds is uniform. Results: Detailed Rasch analyses indicated that the 36-item version of the MCSS could be reduced to 26 items and result in improved fit statistics for six subscales rather than seven. Conclusions: This study reconfirmed the established psychometric properties of the MCSS, now renamed the MCSS-26.

Keywords: MCSS-26; Manchester Clinical Supervision Scale; Rasch Measurement Model; measurement theory; evaluation; clinical supervision

Clinical supervision (CS) has an increasingly established role in the working practices of many health care workforces. In Australia, for example, Health Workforce Australia (an initiative of the Council of Australian Governments [COAG]) has recognized significant challenges to the quality and sustainability of Australian health care and of the potential for CS to make a positive contribution to the governance agenda (Health Workforce Australia, 2011). The important contemporary corollary, therefore, has become the continuous measurement of CS efficacy.

An operational definition of CS, provided by the Open University (1998) has found a growing utility:

Clinical Supervision provides time out and an opportunity, within the context of an ongoing professional relationship with an experienced practitioner, to engage in guided reflection on current practice in ways designed to develop and enhance that practice in the future.

Several models of CS have also evolved, although the so-called Proctor model (Inskipp & Proctor, 2009a, 2009b; Proctor, 1986, 2008) has probably become one of the most influential and widely adopted, not least because it has face validity. It consists of three components as follows:

* Normative: to promote and comply with policies and procedures, development of standards, and contribution to clinical audit

* Restorative: to enable practitioners to better understand and manage the emotional burden of practice

* Formative: to develop knowledge and clinical skills

In operational terms, this has often come to mean that small groups (n 5 ,6), or dyads (one-to-one), of health care personnel arrange to meet within or away from their normal workplace, with an appropriately trained CS supervisor, for 45-90 minutes per session, at monthly frequency, to engage in facilitated reflective discussion, in confidence, around matters of professional relevance and importance. The supervisor and the supervisee(s) are matched with one another, sometimes by choice.


Until a little more than a decade ago, published accounts of the evaluation of the effects of CS were contained to small scale qualitative studies (e.g. …