Supervision in Occupational Therapy: How Are We Doing?

By Gaitskell, Sue; Morley, Mary | British Journal of Occupational Therapy, March 2008 | Go to article overview

Supervision in Occupational Therapy: How Are We Doing?


Gaitskell, Sue, Morley, Mary, British Journal of Occupational Therapy


Occupational therapy has endorsed the practice of clinical supervision to promote high quality services and professional accountability, in line with the Government's governance agenda (Department of Health 1998, 2000). This opinion piece was prompted by a survey of London-based occupational therapists in autumn 2005, which highlighted inconsistencies in the practice and theory of supervision and in the provision of training. The authors argue that managers in health and social care settings should adopt a theoretical framework for supervision; make their expectations explicit; and build an infrastructure, including training and audit, to demonstrate the effectiveness of supervision in improving patient care as well as supporting staff growth.

Key words: Supervision, management, practice development.

Introduction

Clinical supervision has been a central strategy in the Government's quality agenda for health and social care services for many years (Department of Health [DH] 1993, 1998, 2000). It is defined as:

   ... a formal process of professional support and learning which
   enables individual practitioners to develop knowledge and
   competence, assume responsibility for their practice and enhance
   consumer protection and safety of care in complex clinical
   situations (DH 1993).

The value of clinical supervision was endorsed even earlier within occupational therapy and the Statement on Supervision in Occupational Therapy (College of Occupational Therapists [COT] 1990) summarised it as a system for:

   ... ensuring high quality occupational therapy services to the
   consumer ... it is a professional relationship which ensures good
   standards of practice and encourages professional development.

In 1997, this was expanded to reinforce its governance functions and the relationship to accountability (COT 1997, Hunter and Blair 1999). Across all professional groups within the United Kingdom, governance arrangements were strengthened in response to concerns regarding public safety (Clothier et al 1994, Kennedy 2001, Laming 2003). For the allied health professions, regulation now considers competence and continuous learning as well as conduct (Great Britian Parliament 2002). The consequences of these changes are seen in the Management Briefing: Supervision (COT 2006), which reinforces the legal and professional requirements for professional supervision.

Despite these policy imperatives, there has been little research into the effectiveness of supervision within occupational therapy. Hunter and Blair (1999) stressed the need for occupational therapists to understand fully the aims of supervision and suggested that supervision needed to be both supportive and challenging in order to be effective. They summarised the components that are essential to implement supervision successfully within the workplace. These include written supervision contracts, training in supervision, reviews or evaluation, and feedback for both supervisor and supervisee. The authors also challenged the profession to debate the merits and pitfalls of a process that has had limited clinical research.

This call for research into supervision was addressed in part by Sweeney et al (2001a, 2001b, 2001c), who studied the experiences of supervisors and junior supervisees within occupational therapy. Their findings showed that both parties perceived supervision to be a relatively unproductive experience. Many supervisors found supervision difficult and felt uncomfortable in giving feedback or monitoring performance. The supervisees' expectations for advice and feedback from a positive and directive supervisor were largely unmet. Sweeney et al (2001c) concluded that although occupational therapy as a profession has enthusiastically adopted supervision, there is a lack of clarity about its purpose and practice. This adoption of supervision without adequate attention to the theoretical background and training implications is relatively ineffective and costly in terms of time and finances and may be damaging to staff morale. …

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