What is Supervision in Care?

Supervision is a tool used in many workplaces to support, motivate and develop employees. In health and social care, supervision involves the regular meeting of a manager or senior practitioner with staff members, with the aim of reviewing and reflecting on performance, providing support and improving practice.

Supervision should be a two-way process where employees are encouraged to speak openly and can use the process to enhance their learning and development.

Supervision is part of effective performance management and provides evidence for annual appraisals. Supervision can and should increase a staff member’s confidence in their ability to carry out their role, by reviewing workloads, setting goals and expectations, celebrating achievements, and identifying areas for improvements and learning and development opportunities.

In larger organisations supervision can also be used to ensure employees feel valued and part of the wider team by keeping them up to date with the organisation’s news, upcoming events and opportunities.

What are Differences between Supervisions and Appraisals?

Supervision can often be confused with appraisals; they are usually part of the same overall staff performance management and support process and many organisations use similar documents to record both types of meeting.

However, when used effectively there are some key differences between supervision and appraisals:

What are the Key Elements of Supervision?

According to Skills for Care, effective supervisions have three main functions:

Support

Supervision should support staff members in their role by monitoring their health and wellbeing, discussing and addressing issues that may be affecting performance or wellbeing, providing support for any aspects of the role that the staff member is finding challenging and by keeping staff up to date with the organisation’s developments or changes.

Management

Line managers should use supervision to: ensure staff understand and are following relevant policies and procedures, know the standards of care that the organisation expects, review the staff member’s role and responsibilities, delegate work, and communicate any changes to the staff member’s responsibilities or duties. Supervision should also be used to set clear, specific targets and goals to improve performance.

Development

Supervision should be a two-way process where staff are encouraged to reflect on their own practice and learning and development needs. It is also an opportunity for the organisation to gather feedback and reflect on its performance. This can be done by talking to staff about parts of the role they find most challenging, providing and asking for constructive feedback, identifying training needs or any gaps in knowledge and setting targets for addressing these.

What not to do in Supervisions

Supervision should not be used to give a staff member feedback on an area of concern or to address a performance issue for the first time. Concerns and issues should always be addressed at the time; supervisions can then be used to review concerns and issues that have been raised previously and to set very clear goals or expectations.

Supervision should not be used by staff to raise specific concerns or report issues within the workplace; again, it is important that concerns and issues are discussed at the time. Supervisions can be used as an opportunity for staff to identify areas for improvement within their workplace and can talk about any ideas they have for improving services.

The Importance of Supervision

In health and social care your most valuable resource is your staff team – without them you cannot provide a service. Supervision is an investment in your staff team, and when used effectively supervision supports your team to deliver high-quality care and support.

Supervision can:

• Promote effective communication between managers and staff.
• Provide advice, guidance and direction for staff.
• Support learning and development for staff and the organisation.
• Make staff feel valued and positively impact on staff morale and wellbeing.
• Support problem solving and service development.
• Encourage self-reflection.

All these things contribute to high-quality care and support, positive team morale, learning and development opportunities and better outcomes for service users and the organisation.

Lastly, CQC will review a provider’s supervision process and records as part of assessing whether a service is ‘effective’ and ‘well led’. Supervisions are necessary to meet Regulation 18 of the Health and Social Care Act.

The Health and Social Care Act (2008)

Regulation 18 of the Health and Social Care Act outlines the staffing requirements providers must meet. According to CQC this regulation intends to ensure that “providers deploy enough suitably qualified, competent and experienced staff”.

The regulation states:

“18.2 Person’s employed by the service provider in the provision of a regulated activity must –

a. receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform”

If this regulation is breached, CQC can take regulatory action which can include warning notices, imposing conditions of registration, or suspending or cancelling a provider’s registration.

What are CQC’s guidance for Regulation 18?

CQC’s guidance to meeting Regulation 18 includes:

• Supervising staff until they demonstrate required competency levels to carry out their role.
• Providing ongoing supervision to make sure competence is maintained.
• Identifying learning and development needs of staff at the start of their employment and reviewing these regularly.
• Carrying out regular appraisals of staff’s performance.
• Ensuring health, social and care staff who are registered with regulatory bodies (e.g. Nurses registered with the NMC) have access to clinical or professional supervision as required by their regulator.

Providers must meet the requirements of Regulation 18 to achieve a rating of good or above in the areas of ‘Well led’ and ‘Effective’. A provider who doesn’t achieve a rating of at least good in ‘Well led’ is unlikely to achieve a rating of good overall.

How does Supervision link to CQC’s Key Lines of Enquiry?

Supervisions link in to two of the five key questions that CQC seek to answer during an inspection.

These are:

• Is the service effective?
• Is the service well led?

Is the service effective?

When assessing the effectiveness of a service CQC are looking at whether good outcomes are being achieved for people and whether the service is promoting good quality of life for people. CQC also look at whether the care and support being delivered is based on best practice.

When looking at whether the service is effective, CQC use the following Key Lines of Enquiry (KLOE):

“E3. How does the service make sure that staff have the skills, knowledge and experience to deliver effective care, support and treatment?”

The prompts to answering these questions ask about identifying staff learning needs, opportunities for staff development and how staff are supported.

CQC also specifically ask about the arrangements for appraisals, one-to-one meetings and clinical supervision.

Is the service well led?

CQC define ‘well led’ as leadership and management that ensures the delivery of high-quality and person-centred care, supports learning and innovation and encourages and promotes openness and fairness.

When looking at the KLOE’s CQC use to answer this question, supervision contributes to several, including:

• “W3 Is there a culture of high-quality, sustainable care?”
• “W4 Are there clear responsibilities, roles and systems of accountability to support good governance and management?”
• “W5 Are there clear and effective processes for managing risks, issues and performance?”
• “W8 Are there robust systems and processes for learning, continuous improvement and innovation?”

The prompts for these questions include looking at whether staff know and understand the vision, values and strategy of the organisation, if staff feel supported, respected and valued, how staff are supported to develop and if there is evidence that staff and leaders are striving for continuous learning.

More specifically, the prompts also look at whether staff take time out to review individual and team performance and what processes are in place to manage current and future performance.

What are the Benefits of Effective Supervision?

The most obvious benefit of an effective supervision process is that it will support providers to answer CQC’s prompts, KLOE’s and the key questions discussed so far. However, there are also wider benefits, and supervision can contribute indirectly to all the key questions.

Supervision does not only benefit the organisation, but also individual staff, their teams and the people receiving care.

Benefits of supervision for the organisation

• Maintain and improve the quality of services – Supervision will encourage staff to be accountable for their work and reflect on their own performance. Better quality services lead to higher CQC ratings and increased business.
• Ensure staff feel valued and supported – Helping staff to feel confident in their roles and increasing job satisfaction, will reduce staff turnover which in turn will increase service quality and reduce recruitment needs.
• Encourage ongoing learning and development – For both individual staff and the organisation, which will again improve the quality of the service. This can also support the organisation’s future workforce, as supervision can play a role in developing future managers and leaders.
• Reduce costs – High-quality services, lower staff turnover and reduced recruitment needs lead to reduced expenditure, meaning more can then be invested in staff training and development.

Benefits to individual staff and teams

• Increased job satisfaction – Staff will have a clearer understanding of their role and responsibilities and will feel valued and respected by their manager and employer.
• Positive work relationships – Effective supervision supports the development of positive relationships between leaders, managers and their staff and within staff teams.
• Better problem solving – Effective supervision encourages staff to reflect on their own performance and practice in a positive and solutions focused way, meaning that they are more likely to approach problem solving in a positive way and are more likely to feel accountable within their role.
• Improved communication – Effective supervision provides staff with a consistent and regular opportunity to communicate with managers. This will empower staff to have the confidence to initiate contact and communication outside of set supervision times which will lead to better communication within teams.
• Learning and personal development – Effective supervision encourages managers and staff to identify learning needs, create action plans and set goals to address these. If these action plans and goals are implemented staff will be engaged in continuous learning and professional development.

Benefits to the people receiving care

Most importantly, effective supervision will have real benefits for the people that are receiving care and support.

When supervision is being used effectively the people receiving care will:

• Have more consistent staff teams – Due to the reduced staff turnover and increased staff satisfaction.
• Receive the highest quality care and support – As staff are likely to be highly trained and following best practice guidelines.
• Have care and support that is responsive and effective – As staff will be confident in communicating any issues to their managers quickly and will be empowered to engage in positive problem solving to overcome these.

What does ‘Effective’ Supervision mean?

Supervision is effective when it contributes to improving the quality of practice, enables staff to build positive working relationships and encourages a culture of learning and continuous professional development.

Supervision should leave staff feeling motivated, with a clear understanding of their role, responsibilities and targets and the confidence that they can achieve them.

Effective supervision is therefore a mix of performance management (target setting, reviewing performance) and creating a supportive relationship between the supervisor and person being supervised.

Effective supervision is empowering and encourages self-reflection – when a staff member feels supported and safe in their relationship with their manager, they will be enabled to identify areas for improvement themselves.

Signs that Supervision is Being Completed Effectively

Signs that supervision is being used effectively include:

• Staff looking forward to attending or being confident in meeting their supervisor.
• Staff coming to supervision meetings prepared.
• Staff identifying areas of improvement themselves.
• Staff being confident in giving their supervisor/manager feedback.
• Staff being able to tell their supervisor/managers about areas they are finding challenging, or they would like support in.

For the organisation, signs that the supervision process is effective include:

• Positive working relationships between managers and staff.
• Increased job satisfaction ratings from staff.
• Fewer formal complaints or grievances from staff – staff are more likely to raise concerns or issues earlier and resolve them informally with their line manager.
• Improved communication between staff and managers.
• Improved staff retention – staff are more likely to stay in employment with an organisation when they feel valued, when job satisfaction levels are higher and when there are learning and development opportunities.

All of these things contribute to high-quality care and support being delivered and better outcomes for the people using the service and for the organisation itself.

Achieving Effective Supervision

While effective supervision can be very beneficial for organisations, it is not always easy to get right. To develop and implement an effective supervision process the first step must be recognition of the benefits and importance of supervision.

Characteristics of effective supervision include:

• Supervisors are trained, knowledgeable and confident in carrying out supervisory meetings.
• Supervision meetings are pre-planned by the supervisor and the person being supervised.
• Supervision meetings are held in private areas that suit the person being supervised.
• Supervision meetings are planned around the person being supervised and their commitments.
• Supervision meetings are positive meetings which staff are confident in attending.
• Supervision meetings are recorded and minutes/notes are shared with the person being supervised.
• Supervision meetings are rarely cancelled or rushed.
• Supervision meetings are held within a fixed timeframe, e.g. once every quarter/during specific months of the year etc.
• Supervisions are seen by leaders, managers and staff as valuable and essential.

What are the Warning Signs of Ineffective Supervision?

When supervision is not seen as important or valuable by organisations, when there has been little or no investment in a supervision process, or when there is not a clear supervision process, it is unlikely that supervisions will be being used effectively.

Signs of ineffective supervisions are:

• Staff being nervous, worried or even scared about attending supervision.
• Supervision meetings are frequently cancelled, interrupted or not completed in the time allotted.
• Supervisions are infrequent or inconsistent, there’s no set plan for the year.
• No notes are taken or shared following a supervision meeting.
• No actions plans or goals are created from a supervision meeting.
• Staff are not asked for feedback during the process.
• They are completed with no preparation or planning.
• Staff aren’t given prior notice that it’s going to take place.
• Leaders and managers don’t get supervision.
• They are only carried out when there are performance issues or concerns about a staff member or team.

The Impact of Ineffective Supervision

The most obvious impact of ineffective supervision is a negative outcome during a CQC inspection leading to lower ratings or even enforcement action if the process is so ineffective that it can be classed as a breach.

Lower CQC ratings and enforcement action can have a very negative impact on an organisation’s sustainability as it can affect local authority funding and reduce the amount of privately funded business.

Ineffective supervision can be very damaging to a workplace as it can lead to poor working relationships between staff and managers, prolonged conflict within teams or the workplace, increased staff absences, lack of clear direction for staff, poor communication, and reduced job satisfaction. Overall, this will all lead to a reduced quality of care and support.

Lower quality care and support can lead to poorer outcomes for people and reduced quality of life.