Clinical Supervision Audit 2012/13 A High Level Overview of Findings

Clinical Supervision Audit 2012/13 A High Level Overview of Findings Diane Postle, Lead Nurse & Professional Standards Janie Chan, Clinical Audit Officer Audit Period: November 2012 Report Date: January 2013 Clinical Supervision Audit 2012/13 Contents 1 of 16

Contents Page Page Contents... 2 Summary... 3 Background... 5 Aim... 5 Objective 5 Standard... 5 Method... 6 Sample 6 Audit type 6 Service areas/ teams included 6 Findings... 7 Responses received 7 Audit findings 7 Analysis of result 9 Comments... 10 Receiving clinical supervision 10 Frequency 12 Clinical supervision lead 13 Effectiveness of Clinical Supervision 13 Where results to be presented or discussed13 Recommendations... 14 Conclusion... 14 Appendix 1 Action Plan... 15 Appendix 2 Audit Tool... 16 Abbreviations LPT CS CQC CQRG RAG Leicestershire Partnership Trust Clinical Supervision Care Quality Commission Clinical Quality Review Group Red Amber Green A High Level Overview of Findings Contents 2 of 16

Summary Clinical Supervision is a mandatory requirement for clinical staff. It is a requirement of the Quality Schedule to undertake an annual audit to evidence whether clinicians are currently receiving Clinical Supervision. The aim of this audit was to evidence whether clinical staff are currently receiving clinical supervision and where appropriate, to develop action plans to address any areas of poor compliance. This was a baseline audit; the audit was conducted using on an online self-completed survey during two weeks in November 2012. The audit was sent to all clinical staff, 46% of staff responded to the survey. Key findings Criteria/Question % Compliance 1 Are you currently receiving clinical supervision? 89% 2 If yes, how often are you receiving clinical supervision? See table below 3 Do you have a clinical supervision plan/contract? 67% 4 Are you a Clinical Supervision Lead/ clinical supervisor? 37% 5 Has your role as a clinical supervision lead/ clinical supervisor been 67% discussed at your PDR within the last 3 years? (If yes to question 4) 6 Have you received clinical supervision training within your role as a 57% clinical supervision lead? (If yes to question 4) 7 In your role as a clinical supervisee, do you feel that you receive adequate clinical supervision to support your clinical role? 75% How often are you receiving clinical supervision? Frequency Percentage Weekly 5% Fortnightly 4% Monthly 44% Bi-monthly 16% Every three months 18% Once every six months 3% Once a year 2% Other, please specify 8% Overall compliance is minimal. The findings and comments from respondents suggest organisational change, time restraints and competing workloads have affected clinical supervision taking place and influenced the implementation of formalised training for clinical supervision leads/supervisor and the use of clinical supervision paperwork. Key recommendations & actions Divisional leads for clinical supervision to be sent divisional level analysis. A High Level Overview of Findings Summary 3 of 16

Divisions to review comments from clinical staff. Divisional action plans to be developed in order to improve on the uptake of clinical supervision, implementation of clinical supervision plan and training for clinical supervision leads/supervisors. Each division to review results at their next Clinical Audit meetings (to be held in February/March 2013). A High Level Overview of Findings Summary 4 of 16

Background Clinical Supervision is a mandatory requirement for clinical staff. Clinical Supervision is protected time for staff to talk through and reflect on issues that arise as a result of their professional practice, this includes one-to-one sessions or group meetings. It is a requirement of the Quality Schedule to undertake an annual audit to evidence whether clinicians are currently receiving Clinical Supervision. This audit also provides evidence for CQC outcome 14, people are kept safe, and their health and welfare needs are met because staff are competent to carry out their work and are properly trained, supervised and appraised. Aim To evidence whether clinical staff are currently receiving clinical supervision and where appropriate, to develop action plans to address any areas of poor compliance. Objectives To conduct a self- completed questionnaire across the trust to determine of staff that receive clinical supervision in line with the LPT Trust Policy To seek views of respondent to inform the delivery of Clinical Supervision. Standard The commissioners have agreed that this audit will provide a base line as it is the first time a LPT wide electronic clinical supervision audit has taken place. However, the main standards set out in the LPT Clinical Supervision Policy are: Criteria All clinical staff are currently receiving clinical supervision (criterion 1 & 2 the audit tool) All clinical staff have a current clinical supervision plan (also known as clinical supervision contact) (criterion 3 audit tool) All clinical supervision leads to have accessed clinical supervision training (criterion 6 in the audit tool) Standard 100% 100% 100% A High Level Overview of Findings Background 5 of 16

Method This audit was conducted using on an online self-completed survey, appendix 2 (Zoomerang). The link to the survey was emailed to all Heads of Service asking them to cascade and circulate to all their clinical staff. Reminders were sent via the LPT e-newsletter, divisional communication and a personal reminder email was also sent to staff. Data collection began on the 5 th November 2012 with a deadline to complete the audit by 16 th November 2012. At the end of each week a progress update of the responses received was sent to the Heads of Service to monitor return rates and remind staff to complete the audit. To increase the number of returns, the deadline was extended by one week. A paper version of the tool was also available for staff without easy access to emails. Sample The audit was sent to all clinical staff. There are 3888 Clinical Staff in LPT (by head count). Audit type Base line audit. Service areas/ teams included This was a LPT Trust wide audit. All service areas were included in the audit. During the audit, it was identified that the Stop Smoking do not have clinical staff and therefore responses from the Stop Smoking service are not included in analyses. A High Level Overview of Findings 6 of 16

Findings Responses received Overall 46% of clinical staff completed the clinical supervision audit (see table 1). The results are accurate to 95% +/-1.7% (reference to Raosoft sample size calculator). In addition, we received anecdotal comments from managers that staff on maternity leave or long term sick leave would reduce the overall return rate. Table 1 Response Received Clinical head count Number of responses % return 3888 1802 46% Forty eight respondents only completed the demographic information and then abandoned the audit. These responses are excluded from the audit result (i.e. not included in the table 1). Audit findings Table 2 Audit Findings Criteria/Question Total number of staff responded to question Number of staff responding 'yes' % Compliance 1 Are you currently receiving clinical supervision? 1802* 1600 89% 2 If yes, how often are you receiving clinical See table 3 below supervision? 3 Do you have a clinical supervision plan/contract? 1784* 1189 67% 4 Are you a Clinical Supervision Lead/ clinical supervisor? 5 Has your role as a clinical supervision lead/ clinical supervisor been discussed at your PDR within the last 3 years? (If yes to question 4) 6 Have you received clinical supervision training within your role as a clinical supervision lead? (If yes to question 4) 7 In your role as a clinical supervisee, do you feel that you receive adequate clinical supervision to support your clinical role? 1772 647 37% 655* 436 67% 650* 369 57% 1755* 1324 75% *Note: The inconsistency in the total number of staff responded to question column is due to some staff leaving the question blank; this is explained further to the analysis of results section on page 8. A High Level Overview of Findings Findings 7 of 16

The percentage compliance for criterion one was presented to the commissioners for the report to the Clinical Quality Review Group (CQRG). Staff were also asked to provide comments on their experience of clinical supervision and a sample of these comments were included in the CQRG report. Table 3 - Frequency How often are you receiving clinical supervision? (If yes to question 1) Frequency Count Percentage Weekly 88 5% Fortnightly 62 4% Monthly 718 44% Bi-monthly 259 16% Every three months 290 18% Once every six months 43 3% Once a year 28 2% Other, please specify 132 8% Total number of staff responded to question 1620** **There is a difference of 20 staff responding to this question, in comparison to question 1, because 25 respondents stated they do not receive a clinical supervision, however made a comment in the other, please specify field, and five staff stated yes they receive clinical supervision but did not answer the frequency question. Percentage compliance calculation: Yes % Compliance = X 100 Yes + No The compliance achieved is colour coded in accordance with the RAG key below: Key: Acceptable 95-100% Partially acceptable 90% 94% Minimal 89% -0% A High Level Overview of Findings Findings 8 of 16

Analysis of result The table below provides an overview of the results from this audit across the Trust. Table 4 Criteria/Question 2012/13 Compliance Comments 1 Are you currently receiving clinical supervision? 2 If yes, how often are you receiving clinical supervision? 3 Do you have a clinical supervision plan/contract? 4 Are you a Clinical Supervision Lead/ clinical supervisor? 5 Has your role as a clinical supervision lead/ clinical supervisor been discussed at your PDR within the last 3 years? (If yes to question 4) 89% Out of 1802 responses, 1600 (89%) staff stated they are currently receiving clinical supervision. See table 3 - Frequency 67% Out of 1784 responses, 1189 (67%) staff stated they have a clinical supervision plan/contract. 18 respondents left this question blank. 37% 647 staff were identified as clinical supervision leads. This question asked the respondent to take into account group supervision where different people within the group may take turns to supervise the session. 67% Out of the 655 staff that responded yes to question 4, 436 (67%) stated their role as a clinical supervision lead/ clinical supervisor been discussed at your PDR within the last 3 years. Six answered yes they are a CS lead (question 4) and did not answer question 5. Six answered no they are not a CS lead (question 4), however said their role as a clinical supervision lead/ clinical supervisor was discussed at their PDR within the last 3 years. 6 Have you received clinical supervision training within your role as a clinical supervision lead? (If yes to question 4) 57% Out of the 650 staff that responded yes to question 4, 369 (57%) stated they have received clinical supervision training within their role as a clinical supervision lead. Three stated yes they received clinical supervision training within their role as a clinical supervision lead (question 6) but said they are not a CS leads (question 4). 7 In your role as a clinical supervisee, do you feel that you receive adequate clinical supervision to 75% Out the 1755 staff that answered this question, 1324 (75%) of staff felt they received adequate clinical supervision. A High Level Overview of Findings Findings 9 of 16

support your clinical role? Comments Receiving clinical supervision Overall across LPT, the audit identified that 89% of clinical staff (that completed the audit) were currently receiving clinical supervision. The following overall trends in the comments were noted from all staff who responded to, are you currently receiving clinical supervision? Staffing levels staffing levels prioritizing work load organisational changes communication Some staff commented they struggled to have protected time for clinical supervision, due to poor staffing level. An example of this is reflected in the following comments More sessions and staffing levels adequate to attend sessions without having to attend in our own time. Having it and protected time would ensure staff can access it. Doing this survey at home in my own time!! Prioritizing work load Similarly, competing workloads resulted in clinical supervision not taking priority, for example: It does not take place at the moment. Staff are under too much pressure from their workloads and any attempt to organise is difficult. Staff will always prioritise their work. No time to have clinical supervision in work time. No provision has been made to allow me to attend HIV clinical supervision for well over a year. It is a competing priority with low staffing levels and high caseload demands. I think it is becoming increasingly difficult to arrange supervision times when group members are available to attend. A High Level Overview of Findings Comments 10 of 16

Sometimes difficult to keep to times agreed due to the ward activities. Organisational changes Some comments from staff also indicated the organisational changes have affected clinical supervision taking place and plans for clinical supervision were due to commence in the near future; this can be seen in the following examples of comments Due to organization changed formal system due to commence Difficult at present due to major changes within role/base C S due to commence in the near future. Formal supervision commences November 2012. To set up regular peer group and 1;1 (when required) sessions. Due to a change in structure clinical supervision is yet to be set up. Communication Informing staff of the benefits of clinical supervision and letting staff know when the clinical supervision sessions are taking place was a common theme reflected the comments. For example, Staff are currently largely unaware of the place for and benefits of clinical supervision in the work place. It is seen as a tick box exercise that is enforced by management not for the benefit of staff but to ensure that the correct appearance is given of the Trust. communication in the first place, by supervision taking place Vastly increased frequency. Clearer aims. More supportive supervisory relationship. Better communication in and out of supervision. Examples of positive comments from staff The following were examples of comments from all the clinical staff who responded to the audit regarding the clinical supervision they received. I am comfortable with my clinic supervisor and we have built up a therapeutic relationship I feel that meeting regular to discuss any issues which may arise by both parties meets the necessary requirements the helps me in my role. I am very pleased with my clinical supervision, time restraints can sometimes be difficult. A High Level Overview of Findings Comments 11 of 16

I am satisfied with how it is and I find my supervision very helpful. I appreciate my supervisor's experience and insight. I am encouraged to access additional Supervision as needed, this is very helpful. I'm very happy with the level and quality of the supervision I receive. Although planned to be bi-monthly I am confident that my supervisor will respond to urgent situations where additional advice or support is needed. We recently had an update training which was very good and has already improved the quality of our group supervision. I feel that my clinical supervision sessions work well. Only issue is that clinical emergencies with patients take priority and therefore some sessions get put back. It works well for me usually. Sometimes operational matters take up quite a lot of the time leaving little time for clinical reflection / skills. Frequency 1620 responded to question 2, how often are you receiving clinical supervision, a summary of the responses is shown in table 3 (on page 8). It has not been possible RAG rate the frequency (RAG rating explained on page 8), as "the Trust acknowledges that different professional groups will undertake clinical supervision in various forms and will also spend varying amounts of time (Clinical Supervision Policy, pg 30). Therefore, the divisions will be sent the frequency by professional group and asked to determine the RAG status. Clinical supervision plan/contract Overall 67% staff stated they have a clinical supervision plan/contract, this indicates there needs to be a focus on implementing formalized clinical supervision contract/plan for all clinical staff. The following are examples of comments from staff that support this. Having a formalised clinical contract with other Clinical Specialists working in my clinical field would be very beneficial. Through having a supervision contract and a guarantee that the information given will be private and confidential, as there is a section to talk about staffing issues User friendly paperwork and training By having a plan; meeting regularly and documenting outcomes. A High Level Overview of Findings Comments 12 of 16

Clinical supervision lead Of the 647 staff who were identified as clinical supervision leads, 67% had their role as a clinical supervisor/ clinical supervision lead discussed at their PDR and 57% stated they have received clinical supervision training within their role. This suggests training for clinical supervision leads/ supervisors need to be addressed through working with the academy and divisions. Currently, training for clinical supervision leads are monitored at divisional audits through flash report(s). It is noted that some respondents answered the question relating to if their role as a clinical supervisor/ clinical supervision lead was discussed at their PDR and answered the question regarding clinical supervision lead training, however stated they are not a clinical supervision lead/clinical supervisor. It is therefore likely, these staff are not yet clinical supervision leads but have had it discussed at their PDR and/or had training. Effectiveness of Clinical Supervision 75% of staff felt in their role as a clinical supervisee, they received adequate clinical supervision to support their clinical role. The following were examples of how clinical supervision could be improved: More focused on clinical issues, supervisor talking less about own clinical history, discussing difficult patient management Regular supervision, a supervisee that allows me to air my views and would like to have an up to date supervision record Staff are currently largely unaware of the place for and benefits of clinical supervision in the work place. It is seen as a tick box exercise that is enforced by management not for the benefit of staff but to ensure that the correct appearance is given of the Trust. Communication in the first place, by supervision taking place. Maternity leave and service reorganisation has affected my clinical supervision. New team lead to start in post in January where there will be more support By having a plan; meeting regularly and documenting outcomes user friendly paperwork and training Where results to be presented or discussed The high level overview of findings will be reviewed by the Senior Clinical Quality Group. Divisional level results will be reviewed by the overall clinical supervision leads (i.e Clinical Director/Governance leads/lead nurse/ service managers) and divisional clinical audit groups. A High Level Overview of Findings Comments 13 of 16

Recommendations Divisional leads for clinical supervision to be sent divisional level analysis. Divisions to review comments from clinical staff. Divisional action plans to be developed in order to improve on the uptake of clinical supervision, implementation of clinical supervision plan and training for clinical supervision leads/supervisors. Each division to review results at their next Clinical Audit meetings (to be held in March/April 2013). Conclusion Overall across LPT, all criterion scored minimal compliance. Although, the findings show there is scope for improvement, 89% of the staff that responded to the survey stated they are currently receiving clinical supervision. The findings and comments from respondents suggest organisational change, time restraints and competing workloads have affected clinical supervision taking place and influenced the implementation of formalised training for clinical supervision leads/supervisor and the use of clinical supervision paperwork. This report provides a high level overview of findings, divisional level results will be shared with divisional clinical supervision leads. Divisional level report will be written up, recommendation and action to be developed and agreed. A High Level Overview of Findings Recommendations 14 of 16

Appendix 1 Action Plan Objective Improving the uptake of CS Improving the uptake of CS Improve uptake of CS training for clinical supervisor s Improve uptake of CS training for clinical supervisor s Improve uptake of CS training for clinical supervisor s Level of Risk L M H Agreed Action For lead nurse/ CS lead to review divisional uptake of CS with divisional CS lead to inform divisional action plans For lead nurse/cs lead to review comments on how CS can be improved and examples of effective CS, with divisional leads for CS and develop strategies for improving the uptake and quality of CS. Share audit results with academy to inform training Training plan to be implemented & lead by the academy by arranging half day training sessions. Divisional Leads to develop system to monitor uptake of clinical supervision Level of Recommendation Individual, Team, Directorate, Organisation Directorate Directorate Person responsible Divisional CS leads/lead nurse & DP Divisional CS leads/lead nurse Action by date April 2013 April 2013 Resources required Time Time Directorate DP Feb 2013 Time Organisation Mark Dearden, Training lead in the Academy Tbc Time Directorate Divisional CS leads Tbc Time Action Status A High Level Overview of Findings Appendices Action Plan 15 of 16

Appendix 2 Audit Tool A High Level Overview of Findings Appendices Action Plan 16 of 16