Clinical Supervision Policy

Transcription

1 Clinical Supervision Policy A formal process that enables all healthcare professionals to be supported, learn from practice experiences and develop their competence and knowledge. Clinical supervision provides opportunities for healthcare professionals to reflect on practice to assume their own responsibility and enhance patient protection and safety of care within all clinical areas. Key Words: Clinical supervision, Supervisee & Supervisor, Competence, Responsibility, Peer, one to one supervision Version: 8 Adopted by: Quality Assurance Committee Date Adopted: 17 October 2017 Name of author: (owner of policy) Revision by Julie Bowen Learning & Development Name of responsible committee: Date issued for publication: Alison O Donnell Clinical Effectiveness Group October 2017 Review date: April 2019 Expiry date: 1 October 2019 Target audience: Type of Policy: For all healthcare clinical professionals Clinical Non Clinical 1

2 CONTRIBUTION LIST Key individuals involved in developing the document Name Alison O`Donnell Julie Bowen Victoria Peach Lesley Tooley Nicy Turney Heather Darlow Nicola Ward Sam Kirkland Designation Multi Professional Education & Quality Lead Practice Learning Facilitator Head of Professional Practice and Education Clinical Education Lead CHS Senior Nurse Professional Lead FYPC Divisional Governance Manager Workforce Planning Manager Records Transformation and IG Manager Circulated to the following individuals for comments Name Emma Wallis Kathy Feltham Tracey Yole Jude Smith Claire Armitage Laura Smith Learning & Development Group Clinical Education Forum Sandy Zavery Amin Pabani Michelle Churchard Smith Zoe Gilbert Suraiya Hassan Sue Wyburn Jo Wilson Bal Johal Deanne Renny Vicki Spenser Jacquie Burden Steph O Connell Matthew Williams Dr Satheesh Kumar Designation Lead Nurse CHS Lead Nurse MHSOP Lead Nurse for Community Services Head of Nursing Lead Nurse AMH Clinical Trainer AMH Senior Managers and Educators Clinical Educators Equality & Human Rights Service Manager Podiatry Lead Nurse AMH/LD Team Lead HMP Leicester Team Manager OT and Physiotherapy Professional Lead OT Lead Nurse for Community Services Deputy Chief Nurse Speech and Language Therapy Governance Clinical Governance Lead CHS Lead Therapist Lead Nurse AMH - Crisis Resolution Team Medical Director 2

3 Contents Stakeholders and Consultation 2 Version Control and Summary of Changes 5 Equality Statement 6 Due Regard 6 Definition that apply to this policy Purpose of this policy Summary Introduction Modes of Delivery Types and Roles of Supervision Clinical Supervision V Managerial Supervision Clinical Supervision and Staff Responsibilities in the Assessment and Management of Risk Duties within the Organisation Record Keeping and Clinical Supervision Agreement/ Contacts Confidentiality and Clinical Supervision Training Requirements Monitoring Compliance and Effectiveness Links to Standards/Performance Indicators References and Associated Documentation 20 3

4 APPENDICES Appendix 1 Policy Training Requirements 23 Appendix 2 Monitoring Compliance and Effectiveness 24 Appendix 3 Due Regard Screening Template 25 Appendix 4 NHS Constitution Checklist 26 Appendix 5 Divisional Addendums 27 Appendix 6 Flowchart guidance for Clinical Supervision 28 Appendix 7 Clinical Supervision what can we talk about? 29 Appendix 8 Clinical Supervision Agreement 30 Appendix 9 Clinical Supervision Charter 31 Appendix 10 Example: Register / Agreement / ground rules for Clinical Supervision Appendix 11 Example Clinical Supervision Activity log / Framework for 1-1 supervision Appendix 12 Example Clinical Supervision Activity log / Example of Framework for group/peer supervision Appendix 13 Example Clinical Supervision Reflective framework / Example of Framework for one to one supervision Incident/Risk Appendix 14 Example of a Clinical Supervision reflective Framework for group following an Incident/Risk Appendix 15 Using the 6Cs as a reflection tool

5 Version Control and Summary of Changes Version number Date Comments 1 March 2012 Existing policies harmonised 2 October 2012 Addendums added. Greater clarity re management supervision. 3 November 2012 Agreed at Senior Clinical Quality Group 4 February /02/ /03/ /06/ /07/17 Updated NHSLA Monitoring and Self- Assessment Checklist Change of recording documentation Change of addendums from main policy to appendix Adopted by Quality Assurance Committee. Added in Bank staff to target audience and section 1.3 Amended the discrepancies within the policy regarding the minimum frequency of clinical supervision expected. Completed full policy review. Restructure of the policy following feedback from staff engagement via LiA events and through formal channels. Strengthen the variety of modes of delivery for clinical supervision to enable greater flexibility for staff. Clarification of the key differences between managerial and clinical supervision. Review of clinical supervision agreement requirements. For further information contact: Learning and Development 3 Gilmour Close Beaumont Leys Leicester LE41EZ 5

6 Equality Statement Leicestershire Partnership NHS Trust (LPT) aims to design and implement policy documents that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the provisions of the Equality Act 2010 and promotes equal opportunities for all. The Clinical Supervision Policy has been assessed to ensure that no one receives less favourable treatment on the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity. In carrying out its functions, LPT must have due regard to the different needs of different protected equality groups in their area. This applies to all the activities for which LPT is responsible, including policy development and review. Due Regard The Trusts commitment to equality means that this policy has been screened in relation to paying due regard to the Public Sector Equality Duty as set out in the Equality Act 2010 to eliminate unlawful discrimination, harassment, victimisation; advance equality of opportunity and foster good relations. A due regard review found the activity outlined in the document to be equality neutral because all staff in clinical areas must be able to access clinical supervision and any additional requirements will be able to be assessed on an individual basis. This is evidenced by the distribution list, the equality statement and the confidentiality statement. The supervisee will sign a supervision agreement prior to commencing clinical supervision. The agreement lists issues that are appropriate to the supervision process and will not affect any potentially disadvantaged groups. See appendix 3. The policy will be regularly reviewed to ensure any inequality of opportunity for service users, patients, carers and staff is eliminated. 6

7 The NHS Constitution NHS Core Principles The NHS will provide a universal service for all based on clinical need, not ability to pay. The NHS will provide a comprehensive range of services Shape its services around the needs and preferences of individual patients, their families and their carers Respond to different needs of different sectors of the population Work continuously to improve quality services and to minimise errors Support and value its staff Work together with others to ensure a seamless service for patients Help keep people healthy and work to reduce health inequalities Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance 7

8 Definitions that apply to this Policy All procedural documents should have a definition of terms to ensure staff have clarity of purpose (refer to Policy for Policies for assistance) Definitions are a Core Standard. Clinical Supervision One to One Peer group, team Confidentiality Clinical Supervisor Clinical Supervisee Record Keeping Responsibility Agreement Due Regard A formal process of professional support and learning that enables individual practitioners to develop knowledge and competence, be responsible for their own practice and patient protection and safety of care in a wide range of situations Sharing of a topic from clinical practice and discussions between supervisor and supervisee Sharing of topic from clinical practice between supervisor and more than one supervisee, from the same or different health care professions. All issues discussed will be in confidence, unless there is anything disclosed that affects the wellbeing of the supervisee or is detrimental to patients, professional practice, the team, or the organisation. A Healthcare professional who is trained to facilitate clinical supervision sessions. Healthcare professional who engages in clinical supervision activity. To maintain a history of activity by the recording of clinical supervision activity in documents (electronic or paper) such as clinical supervision activity logs (appendix 6) It is the responsibility of all healthcare staff to update their own record on ulearn (both registered and unregistered) All healthcare staff should be aware of their personal/ service agreement and follow the guidelines of this policy at all clinical supervision sessions. Having due regard for advancing equality involves: Removing or minimising disadvantages suffered by people due to their protected characteristics. Taking steps to meet the needs of people from protected groups where these are different from the needs of other people. Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low. 8

9 1.0 Purpose This policy has been developed to: 1.1 Ensure all healthcare professionals (Clinical Staff) both registered and unregistered are aware of the Trust s commitment to ensure Clinical Supervision is accessible for all staff employed in a clinical capacity in all Directorates / Services within the Trust. 1.2 Provide guidance by describing the requirements and expectations of clinical supervision for all health care professionals who are employed by Leicestershire Trust. 1.3 Outline the importance of clinical supervision and the role it plays in the development of all health care professionals. This is in accordance with regulations set out by professional regulatory bodies and their specific requirements and codes of conduct. 1.4 Establish clear processes for clinical supervision to enhance consumer safety and protection for the patient by ensuring that all care provided is delivered by skilled safe and knowledgeable practitioners 1.5 Maintain the quality staff of clinical supervision to a common set of principles and standards, supported by a variety of modes of delivery in accordance with trust requirements. 1.6 Improve the quality of care by the use of supervision techniques, which allow individuals to assess their own performance and make any necessary changes to improve poor practice, enabling professional development, education and training. 1.7 Enable staff to share good practice and support the development of clinical expertise and innovation in practice. 2.0 Summary 2.1 This is an overarching policy providing guidance on Clinical Supervision across a wide range of healthcare professions. All healthcare professionals both registered and unregistered are expected to engage with clinical supervision. 2.2 The minimum requirement of Leicester Partnership Trust is for staff to engage with clinical supervision once per quarter for a minimum of one hour. 2.3 Clinical supervision forms one part of a wide range of support strategies for health care professionals. Other strategies include management supervision, preceptorship, mentorship, and supervision of practice, development of professional standards, peer review and Appraisal. 9

10 2.4 It can ensure best practice and improvements in care through clinical governance. Clinical Supervision is described as an innovative way of using shared learning through reflective practice and shared experiences. It can ensure best practice and improvements in care through research, clinical governance and the compassion in practice framework 2.5 Each Directorate has developed their own service expectations and addendums. These outline the expectations for each service in relation to Clinical Supervision and reflect the complexity of care and support required for staff across a wide range of services. All clinical staff must liaise with their line manager to know the maximum and minimum amount of sessions that will be required for that service. See appendix It is each individual s responsibility to update their own clinical supervision record in accordance with monitoring requirements via ulearn. 3.0 Introduction 3.1 The overall aim of Clinical Supervision are to enable the health care professional (supervisee) to achieve, sustain and creatively develop a high quality of practice through the means of focussed support, reflection and continued professional development. Guidance form the Care Quality Commission advises that; It can help staff to manage the personal and professional demands created by the nature of their work. This is particularly important for those who have complex and challenging needs clinical supervision provides an environment in which they can explore their own personal and emotional reactions to their work. It can allow the member of staff to reflect on and challenge their own practice in a safe confidential manner CQC (2013) 3.2 The Nursing and Midwifery Council (NMC 2015) supports the establishment of clinical supervision as an important part of clinical governance and in the interests of maintaining and improving standards of patient and service user care. The revised code states that nurses should share their skills, knowledge and experience for the benefit of people receiving care and their colleagues. 3.2 The Health Care Professions Council standard of proficiency recognises the importance of clinical supervision alongside other forms of Continuing Professional Development as do specific bodies of the Allied Health professions e.g. College of Occupational Therapists and Physiotherapy (HCPC 201) 4.0 Clinical Supervision Modes of Delivery 4.1 There are several modes of delivery and healthcare staff may access a variety of these in practice. The mode of delivery will be determined by the service within which you are employed and organisational capacity and in 10

11 accordance with professional requirements as set out by regulatory bodies; for example: Psychologists, Medical staff Allied Nursing and Health Care Professionals Occupational Therapists, Physiotherapists, Pharmacy, Midwives and Health Visitors The Trust acknowledges that different professional groups will undertake clinical supervision in various forms and will also have different frequency requirements. All health care professionals must be afforded protected time to undertake clinical supervision. The modes of delivery are: One to one supervision: this type of clinical supervision usually takes place between two members of the same staff group with the supervisor being senior to the supervisee. Peer Group Supervision: takes place within a small group setting, with the same grade staff who have equal experience and share the supervision session equally. The supervisor must have the expertise to guide and support the supervisees. Multidisciplinary Group Supervision: This model of clinical supervision takes place between a facilitator and a group. The facilitator does not have a line management responsibility with the group and the supervisees will be from different disciplines. Network Supervision: is between professionals and could involve a specialist topic. An example of this is where professionals from different trusts link to share expertise. 5.0 Types and role of Supervision in Practice 5.1 Other methods of supervision co-exist to support each individual throughout their career as a health professional. Effective clinical supervision will incorporate elements of all these aspects, providing a powerful toolkit for personal and professional development. If a balance between models of supervision is not achieved, for example the managerial function is stressed at the expense of others then supervision becomes a management tool that can stifle creativity and innovation. Likewise if the supportive role dominates it could prevent decisions or actions being achieved Managerial supervision This form of supervision focuses on service development, caseload management and day to day issues of regarding team working, service delivery, environment and workplace. This type of supervision is delivered by the supervisee s line manager and must be provided on a consistent basis. 11

12 Professional supervision Professional supervision supports safe and effective service delivery through an application of ethical codes and professional standards. It should allow for reflection on current professional issues, developments and changes relevant to any professional group. An example of this is the trust preceptorship programme that allows newly qualified staff nurses to access shared learning to develop their professional skills. Educational Supervision Educational supervision aims to ensure best practice and encourages and challenges the supervisee to continually improve, extend and develop their practice and skills. It will provide the supervisee with the knowledge to ensure their practice is safe and of a high quality. This aspect of supervision forms an important part of the supervisee s appraisal plan by increasing expertise and innovation and developing their scope of practice. Informal Supervision Gardner et al (2010) describe `superficial supervision` whereby staff may not engage in reflective supervision because they perceive that their difficulties have been resolved through informal or `corridor` conversations with their colleagues. Clearly et al (2010) recognise that these conversations support nurses in daily care management providing ongoing opportunities to discuss problematic situations that can help to contain anxieties, reduce the feeling of isolation and relieve stress. Gardner et al acknowledged the value of such an informal approach, however they concluded that some issues should be followed up within formal supervision activity as informal interactions are unstructured and do not allow for deep understanding or reflection. 6.0 What is the difference between Management Supervision and Clinical Supervision? 6.1 The key difference is that the Manager leads Management Supervision. In Clinical supervision, the Supervisee leads and sets the agenda. Generally, clinical supervision is seen as complimentary to but separate from, managerial supervision, which is about monitoring and appraising staff performance. However, both should be used to obtain information on development to support and feed into the appraisal process and support in your practice and the services where you are employed. 12

13 Management Supervision supports staff by: Review of performance / appraisal Setting priorities / objectives for the team in line with organisational objectives Supports staff with managing sickness and absence Plans and updates annual leave / time owing to ensure safe staffing levels Clinical Supervision supports staff by: Being self driven and self - owned by participants Listening and being heard, affirming, inclusive and being mutually supportive for all Being open to questions and receptive of challenges in a constructive way Exploring the relationship between actions and feelings Management of risk / caseload management Providing a safe place to explore and share the burdens of work Team administration and resource issues Facilitating a structured framework for reflection thinking Data Quality updating / audits Learning and development Clinical Governance Understanding accountability 7.0 Clinical supervision & Staff responsibility in the assessment and management of risk 7.1 The assessment and management of risk is core to the role of clinicians in contemporary health services. While it is unrealistic to expect that all adverse incidents can be prevented, the risk for each individual can still be identified, managed and possibly avoided. The Trust Clinical Risk Assessment Policy (2012) makes it clear that issues regarding clinical risk assessment must be reviewed in clinical supervision. The policy states that it is the supervisee s responsibility to regularly discuss risk assessments, particularly those of high risk cases with their supervisor. 7.2 Ultimately the purpose of clinical supervision is to safeguard the wellbeing of the client and assist with the development of the supervisee, thus making clinical supervision an important contribution to the way we manage clinical risk (Banks et al 2012, Tingle 1995) By adopting proactive patient management strategies and reflecting on skills, the risk of adverse events occurring will be reduced. 13

14 7.3 Waller and Clark (1999) suggest that clinical supervision can offer compassionate risk management by addressing early warning signs that can herald a more serious risk to patients. Many clinicians receive supervision for cases that are seen as particularly challenging, stuck or risky. While it is important to prioritise such cases, supervisors should be aware of the need to focus on cases that appear more straightforward as it is possible to miss something that supervision can appropriately address. 7.4 Ladany 2004(cited in Turpin and Wheeler 2007) has reported the failure of some therapists to disclose ongoing difficulties within their clinical work in supervision, which might reflect poorly on their own competence and performance as therapists. Supervisors must ensure that consideration is given to the strengths and weakness of the assessment carried out and the documentation and care planning around risk assessment if appropriate. 8.0 Duties within the Organisation The Trust Board has a legal responsibility for Trust policies and for ensuring that they are carried out effectively. The Trust is fully committed to this policy and supporting the staff group identified in the policy to access clinical supervision Trust Board Sub-committees have the responsibility for ratifying policies and protocols. The Clinical Effectiveness Group will approve and monitor implementation this policy 8.1. Divisional Directors and Heads of Service are responsible for: Implementation of this policy within their Directorate / Service and promoting a positive culture where clinical supervision is valued and protected to enable supervisory relationships to flourish and empower staff to develop their clinical skills. 8.2 Line Managers and Team leaders are responsible for: Ensuring that members of staff within their teams are made aware of this policy and their responsibilities under its terms. Ensuring staff have access to the clinical supervision charter see appendix 9 to understand their role and responsibilities in clinical supervision Ensuring that staff access clinical supervision a minimum of 4 times a year I session each quarter for a minimum of 1 hour with a supervisor who has the expertise and experience to provide guidance and support. Ensuring all clinical staff who report directly to them receive regular clinical supervision in accordance with the standards set by this policy 14

15 Checking that the date and time of clinical supervision sessions is recorded, logged and available for divisional monitoring purposes and that staff are logging the sessions onto the Trust Learning Management System ulearn. That adequate time and opportunity is allocated to attend clinical supervision sessions. This will be as part of the working day and agreed in advance with both parties. Ideally it is not recommended that the line manager provides clinical supervision as it could lead to a conflict of interest and boundaries will become blurred. However if individual supervisees are in agreement for their line manager to be their supervisor this will be supported. 8.3 Clinical Supervisors are responsible for: Drawing up a written supervision agreement with each person / group they supervise see appendix 8. Ensuring that supervision records are stored in accordance with procedures outlined in this policy. Guiding the supervisee through a process of discussion and reflection in order to support, challenge and assist the supervisee to develop their clinical practice and competency using activity log/frameworks and completing reflection practice documents. See appendix examples. Ensuring that they do not assume accountability or responsibility for the supervisee`s patients or clients. However they will be accountable for the advice they give and the action they take. Supervisors must remain up to date with current practice and legislation to ensure the advice they give is correct. Being trained in the process and facilitation of clinical supervision and use the Trust values and 6c`s framework to assist the process. Recording and monitoring attendance at sessions and for informing the line manager or team lead of any serious concerns regarding practice or attendance. Ensuring that supervision is conducted in a collaborative format that promotes active engagement where individuals openly discuss their practice. Ensuring that all supervisees are informed that they must log the session individually on the Trust Learning Management System ulearn for a minimum of one hour, once per quarter... 15

16 8.4 Clinical Supervisees are responsible for: Reading the trust policy and completing the e learning module and assessment on ulearn to understand their responsibility in clinical supervision. Accessing clinical supervision sessions for a minimum of one hour once per quarter. Recognising and developing their personal and professional practice and competency through reflection, support and challenge. Ensuring they are supported by an experienced supervisor to achieve this and using the 6c`s process framework to assist the process. Compassion In Practice (2013) Maintaining accountability and responsibility for their patients/ client. Drawing up a written supervision agreement with their supervisor/ following guidelines outlined within this policy Ensuring that supervision records are stored in accordance with procedures outlined in this policy. Informing their line manager of the date and time of the supervision session to enable the accurate records of attendance Recording the session individually on the Trust Learning Management System ulearn for a minimum of one hour, once per quarter. 9.0 Record keeping and Clinical supervision 9.1 Clinical supervision must be recorded to ensure that discussions and agreed actions can be referred back to by both parties as part of an ongoing process of monitoring, development and support for the supervisees practice. 9.2 There is no stipulated time frame to keep clinical supervision records. Clinical supervision records are a personal record of development, therefore it is recommended that the records are kept in line with the standards of the individuals` profession to allow for reflection if required at a later date. An example of this is revalidation for nurses where information from the previous 3 years can be used as evidence for their portfolio. 9.3 Clinical supervision registers must be completed at each session to demonstrate attendance and copies sent to team leads/managers. Supervisees must also record the date of attendance on the trust learning management system ulearn for accurate monitoring and audit information. The Trust minimum requirement for this is for a minimum of one hour, once per quarter. 16

17 9.4 Documents recording the content of clinical supervision and the clinical supervision agreement / contract must be stored securely and confidentially by the supervisor, individual or group depending on the type of supervision and only shared with all parties agreement. See appendix 8,9, 10,11,12 for examples of recording documentation. 9.5 The supervisee can also use any evidence of learning and development from the clinical supervision records for their portfolio and annual appraisal but must maintain any confidential information. 9.6 At the first meeting an agreement should be reached on who is responsible for writing the supervision record and both supervisor and supervisee should sign and retain a copy. See appendix Any decisions made as part of the clinical supervision process regarding a specific patient or service user s care must be recorded in their clinical record in line with the Trust Record Keeping Policy Clinical supervision can involve providing information about a patient that the supervisor has not seen. The Department of Health (2010) outlines the following principles that should be adhered to: 9.9 The clinical supervisor should ask sufficient information about the case to be comfortable in providing guidance and advice. There needs to be proportionality, so if documented the record should say `based on the information I have received`. Best practice within clinical supervision is that if there is telephone contact between supervisee and supervisor the advice should subsequently be provided in writing so that it can be incorporated into other records if the situation requires. Agree who will record the advice this may often be the person who has requested it. This can be done by but must be in line with Trust Data Protection, Caldicott and Confidentiality Policy (2015) Agreements / Contracts 10.1 Professional bodies in both Health & social Care emphasise the value of having clear supervision agreements /contracts as being an effective way to develop both understanding why and what it is about. It is based on a professional working relationship that provides for joint understanding and responsibility. An effective working agreement will reduce ambiguity and provide a safe framework / process within which relationships can progress and flourish in an open transparent way A clinical supervision agreement/ contract provides explicit detail of how clinical supervision will take place, explains practical details and ground rules Best practice suggests that at each Clinical Supervision session all staff should be reminded of the content of an agreement and ground rules. By following these rules and the process for clinical supervision all participants are treated fairly and equally. 17

18 11.0 Confidentiality 11.1 All issues discussed will be in confidence, unless there is anything disclosed that affects the wellbeing of the supervisee or is detrimental to patients, professional practice, the team, or the organisation Clinical Supervisors are accountable for the supervision they provide and for ensuring that the risk is actively monitored within supervision. Supervision should be safe, sound and supportive. It is a time to discuss the supervisee s needs, issues and concerns and subsequent learning opportunities it will take place in a quiet confidential environment without interruptions Clinical supervisors have a clear responsibility to liaise directly with a supervisee`s Line Manager if there are any issues or concerns arising from clinical supervision. Although the supervisor has responsibility to the supervisee and the Trust confidentiality policy, the primary responsibility remains the welfare of the service user or patient The supervisor has the responsibility to ensure the supervisee is fit to practise and to take any appropriate action if any concerns are identified (Turpin and Wheeler, 2007) in a disciplinary setting, supervisory notes may be required For group/peer clinical supervision the information that is confidential will be decided by the group and individuals in the group must agree on what information can be shared or the group dynamic will be lost. Any issues or concerns regarding individual supervisees will be addressed by the supervisor as an action If information is to be shared electronically you must only share or exchange personal sensitive information in line with trust policy and procedures including the Data Protection, Caldicott and Confidentiality Policy Training There is a need for training identified within this policy. In accordance with the classification of training outlined in the Trust Learning and Development Strategy this training has been identified as role development. Please see appendix 1. Training for clinical supervisors will be a four hour classroom session exploring the facilitation, process and recording of clinical supervision. This will be once only and accessed through the Trust Learning Management System ulearn. Training on the process of clinical supervision for all staff will be an e learning module accessed through the Trust Learning Management System ulearn. Details of the session will be recorded individually on the Trusts Learning Management System ulearn. 18

19 The Clinical Effectiveness Group will be responsible for monitoring the training Monitoring Compliance and Effectiveness There will be Trust level monitoring in line with the Clinical Supervision Policy. Compliance in relation to Clinical Supervision is monitored on a monthly basis The Trust Learning Management System ulearn will be used to record and evidence clinical supervision. The data generated will monitor the compliance, training implementation and quality of clinical supervision for all healthcare staff. It will be the responsibility of the Clinical Effectiveness Group (CEG) to provide assurance on the uptake of clinical supervision. The resulting outcomes will inform where action plans are needed to improve compliance. CEG will receive a quarterly report based on the information collated from the Trust Online management system ulearn Divisional monitoring will also take place in line with local clinical supervision addendums. Team managers are responsible for monitoring compliance within their clinical area. See Monitoring Tool Appendix 2 in the template document Links to Standards/Performance Indicators A description of how the procedural document links to Care Quality Commission (CQC) Outcomes (E.g. Outcome/Regulation number and domain) or other standards/performance indicators should be included (e.g. Essence of Care, National Patient Safety Advisor Agency notices, NICE guidance). TARGET/STANDARDS KEY PERFORMANCE INDICATOR CQC outcome 14: Care and welfare of Outcome 14 people who use services Supporting Workers CQC Outcome12: People should be cared Outcome 12 for by staff who are properly qualified and Requirements relating to workers able to do their job NHSLA Risk Management Standards Standard NMC Code of Conduct (2015) Section 9 Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues 19

20 15.0 References and Associated Documentation This policy was drafted with reference to the following: Banks D. Clifton A. Purdy M. and Crawshaw P. (2013) Mental health nursing and the problematic of supervision as a confessional act Journal of Psychiatric and Mental Health Nursing, Bond M. Holland S. (1998) Skills of clinical supervision for nurses. Open University Press Buckingham Butterworth T. Faugier J. (1992) Clinical supervision and mentorship in Nursing. Chapman and Hall London Cleary, M. Horsfall, J. and Happell, B. (2010) Establishing Clinical Supervision in Acute Mental health Inpatient Units: Acknowledging the Challenges Clinical Supervision :a high level Overview of Findings (2015) Leicestershire Partnership Trust Compassion in Practice: A summary of the Implementation Plans (2013) NHS Commissioning Board. CQC Essential Standards of Quality & Safety [2010] Care Quality Commission. London Care Quality Commission (2013) Supporting information and guidance supporting effective supervision. London. CQC. Department of Health (2010) Responsibility and Accountability - Moving on for New Ways of Working to a creative, capable workforce, Best practice guidance East Cheshire Clinical Supervision Policy (2014) Equality analysis and the equality duty: A guide for public authorities Vol. 2 of 5 Equality Act 2010 guidance for English public bodies (and non-devolved bodies in Scotland and Wales), Equality and Human Rights Commission Gardner, A., McCutcheon, H. and Fedoruk, M. (2010) superficial supervision: Are we placing clinicians and clients at risk? Contemporary Nurse Gibbs, G. (1988) Learning by doing: A guide to teaching and Learning. London. Hawkins, P. and Shohet, R. (2000) (2nd edition) Supervising in the Helping Professions. An individual group and organisational approach. Milton Keynes, Helen Douglas House (2014) Clinical Supervision toolkit. 20

21 Ladany, N., Friedlander, M. L., & Nelson, M. L. (2005). Critical events in psychotherapy supervision: An interpersonal approach. Washington, DC:, American Psychological Association Leicestershire County and Rutland Organizational wide Policy for the development and management of procedural documents Leicestershire Partnership Trust (2014) Appraisal Policy Leicestershire Partnership NHS Trust (2014) Clinical Risk Assessment Policy Leicestershire Partnership Trust (2012) Clinical Supervision Policy Leicestershire Partnership Trust (2015) Data Protection, Caldicott and Confidentiality Policy Leicestershire Partnership Trust (2015) Preceptorship Policy Leicestershire Partnership Trust (2014) Record keeping and the Management of the Quality of Health Records NHSLA Risk Management Standards for NHS Trusts providing Acute, Community, or Mental Health & Learning Disability Services and Non- NHS Providers of NHS Care [2011] NHS Litigation Authority. London. NMC Code of Conduct (2015) Richards M & Payne C [1990] Staff supervision in child protection work. National Institute for Social Work. Royal College of Nursing [2008] Clinical Supervision in the workplace. Royal College of Nursing. London. Sussex Partnership NHS Foundation Trust Clinical supervision Policy (2014) Skills for care (2007) Providing effective Clinical Supervision. A workforce development tool. Tingle, J. (1995) Clinical supervision is an effective risk management tool. British Journal of Nursing 4(14): Turpin, G. and Wheeler, S. (2007) IAPT Supervision Guidance, University of Sheffield and University of Leicester Walker, R. and Clark, J.J. (1999) Heading off boundary problems: clinical supervision as risk management. Psychiatric Services 50(11):

22 Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients: a systematic review of the literature. Lutterworth, BACP. Leicester Partnership Trust Mini Toolkit Clinical Supervision Guidance V8 Draft 22

23 Appendix 1 Policy Training Requirements The purpose of this template is to provide assurance that any training implications have been considered. Clinical Supervision for Supervisors- this is a half a day course that will assist clinical supervisors to facilitate and record clinical supervision Training topic: Type of training: Clinical Supervision for all staff undertaking supervision this is an e learning module that will provide information on the concept of clinical supervision and why it is required. There will be an assessment at following the completion and a score of 80% will be required to pass the module Mandatory (must be on mandatory training register) Role specific Personal development Division(s) to which the training is applicable: Staff groups who require the training: Adult Learning Disability Services Adult Mental Health Services Community Health Services Enabling Services Families Young People Children Hosted Services Clinical Supervision for all staff undertaking supervision = All staff employed in a clinical role across the trust who must undertake clinical supervision Clinical Supervision for Supervisors = All clinical staff who are supervisors in clinical supervision Update requirement: Who is responsible for delivery of this training? Have resources been identified? Has a training plan been agreed? Once Learning and Development Service/ clinical educators Yes this is already in place Yes this is already in place and is accessed through U learn Where will completion of this training be recorded? Trust learning management system Other (please specify) How is this training going to be monitored? Through audit and monitoring from the trust learning management system and reports to the Clinical Effectiveness Group 23

24 Appendix 2 Process for monitoring Compliance and Effectiveness Duties outlined in this Policy will be evidenced through monitoring of the other minimum requirements Where monitoring identifies any shortfall in compliance the group responsible for the Policy (as identified on the policy cover) shall be responsible for developing and monitoring any action plans to ensure future compliance Reference Minimum Requirements Self - assessment evidence Clinical supervision will be completed and recorded for a minimum of one hour, once per quarter over a 12 month period. Para , 12 Process for Monitoring Learning Management System Responsible Individual / Group Clinical Effectiveness Group Frequency of monitoring Quarterly 24

25 Appendix 3 Due Regard Screening Template Section 1 Name of activity/proposal Clinical Supervision Policy Date Screening commenced 25 th February 2015 Directorate / Service carrying out the Enabling assessment Name and role of person undertaking Julie Bowen this Due Regard (Equality Analysis) Practice learning Facilitator Give an overview of the aims, objectives and purpose of the proposal: AIMS: The policy identifies that all staff in the Trust employed in a clinical role must have clinical supervision as a minimum of once per quarter for a minimum of one hour each session OBJECTIVES: To provide clinical staff with information regarding the standards and their responsibilities in order for them to meet their professional obligations in accessing and monitoring clinical supervision Section 2 Protected Characteristic Age Disability Gender reassignment Marriage & Civil Partnership Pregnancy & Maternity Race Religion and Belief Sex Sexual Orientation Other equality groups? If the proposal/s have a positive or negative impact please give brief details All clinical staff must access clinical supervision All clinical staff must access clinical supervision. Reasonable adjustments will be made to ensure all information is accessible to all staff to meet any specific need/s. Please refer to Trust Reasonable Adjustment Policy All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision All clinical staff must access clinical supervision Section 3 Does this activity propose major changes in terms of scale or significance for LPT? For example, is there a clear indication that, although the proposal is minor it is likely to have a major affect for people from an equality group/s? Please tick appropriate box below. Yes High risk: Complete a full EIA starting click here to proceed to Part B No Low risk: Go to Section 4. 25

26 Section 4 If this proposal is low risk please give evidence or justification for how you reached this decision: All clinical staff will access clinical supervision. If there are any individual requirements needed to assist with access identified it will be the responsibility of the individual, the clinical supervisor and the individuals line manager to ensure this is recognised and acted upon Signed by reviewer/assessor Date Sign off that this proposal is low risk and does not require a full Equality Analysis Head of Service Signed Date Appendix 4 The NHS Constitution NHS Core Principles The NHS will provide a universal service for all based on clinical need, not ability to pay. The NHS will provide a comprehensive range of services Shape its services around the needs and preferences of individual patients, their families and their carers Respond to different needs of different sectors of the population Work continuously to improve quality services and to minimise errors Support and value its staff Work together with others to ensure a seamless service for patients Help keep people healthy and work to reduce health inequalities Respect the confidentiality of individual patients and provide open access to information about services, treatment and performance 26

27 Appendix 5 Divisional Addendums Service Maximum sessions over 12 months Adult Mental Health AMH Clinical supervision will be 12 and Learning Disability LD sessions per year. Maximum Services interval between supervision will be 8 weeks to allow for annual leave commitments. Additional sessions can be requested by the supervisee or supervisor according to need and accepted clinical practice Community Health Services Clinical supervision will be 12 sessions per year depending on the clinical area that they work in. Staff must check with their line manager of the maximum requirements for their role Community Health Services for Older People MHSOP Families, Young People and Children FYPC Clinical supervision will be 12 sessions per year. Further sessions can be requested by the supervisor or supervisee according to need and accepted clinical practice Clinical supervision will be 12 sessions per year depending on the clinical area that they work in. Staff must meet with their line manager to ensure they know the maximum requirements for their role LPT Pharmacy Services Clinical supervision will be 6 sessions per year Minimum sessions over 12 months The minimum amount of sessions will be 10 to take into account annual leave Staff must have clinical supervision 4 times a year The minimum amount of sessions will be 10 per year to take into account annual leave The minimum amount ranges from 4 times a year to 12 times per year depending on the clinical area that they work. Staff must liaise with their line manager to ensure they know the minimum requirement for their role The minimum amount of sessions will be 4 times per year The trust requirements for monitoring and compliance of clinical supervision is a minimum of four times a year one per quarter for one hour at each session 27

28 Appendix 6 FLOW CHART GUIDANCE FOR CLINICAL SUPERVISION PREPARATION Prepare for the meeting in advance, protected time, suitable location, free from interruptions, prepare paperwork required, have you got a copy of the last record for review and discussion (if applicable) ORGANISATION Safeguarding: Best practice acknowledges that all Nursing and Allied Health Professionals should be aware of the principles / ground rules outlined within a Clinical Supervision agreement at every Clinical Supervision contact. These are outlined within the policy ACTIONS Have any actions, training or further development needs been identified / agreed by all participant/s? Agree the entries into the activity log, who will complete each action? and record this Complete activity logs RECORDING SUPERVISION NOTES In the interest of all participants, supervision notes should be promptly & properly recorded. All participants should be made aware of how these may accessed or retain a copy as a personal record. It only takes a minute Record on ulearn Supervision Tab 28

29 Appendix 7 Clinical Supervision what can we talk about? Participants in clinical supervision describe events/ experiences from their practice which is pertinent to them as an individual or a topic affecting / chosen by the group. Example: reviewing a critical incident / debrief or a topic to explore what happened, share best interest principles or research evidence and learn from this. An issue or incident from practice Describe and define this What are your actions? How might your practice change in the future? How did this make you feel? Evaluate the results. What would you do differently next time? Analyse and reflect on what happened A reflective cycle Clinical Supervision 29

30 Appendix 8 Verbal / written guidance Clinical Supervision Agreement Supervisee and Supervisor will agree to the following That we will meet as agreed by the service (this will differ for different services in the trust so must be agreed by the line manager) Sessions will be supported and recorded in line with trust policy. Privacy must be ensured with no interruptions. The session will enable the supervisee and supervisor to discuss, explore and reflect on issues affecting practice, to support the development of personal and professional knowledge in order to sustain and develop high quality practice. The content of the clinical supervision session will include: Reviewing and reflecting on clinical practice Discussing current issues, concerns and risk assessments Discussing issues related to professional development Agreeing upon actions where identified and ensuring that the actions are completed. We will work together to develop clinical supervision and be open and honest on how we give feedback to each other. We will ensure we work in the boundaries of confidentiality in relation to clinical supervision and will not include anything that is illegal or contravenes the code of professional conduct or trust policy. We agree to commit to clinical supervision on the dates agreed. If the session is cancelled it will be the responsibility of the person who cancels to rearrange the session. If the supervisory partnership becomes ineffective or difficulties arise either supervisee or supervisor can, following discussion terminate the agreement. If this occurs the supervisee must seek support from their line manager to identify a new supervisor As supervisee, I agree to: Be responsible for making effective use of my time, by preparing for the session and knowing my agenda To identify and action any learning or development needs To identify practice issues for discussion and be open to feedback regarding possible interventions and solutions To take responsibility for any actions or outcomes following the clinical supervision session As supervisor, I agree to: Provide an environment that allows the supervisee to explore, clarify thinking and share experiences. Give clear feedback, offering support and guidance regarding the situations the supervisees talks about Provide advice, information and sign posting to allow the supervisee to reflect and develop their professional practice Always consider our Trust Values and Compassion in Practice (6c s) 30