Abstract
BackgroundTo ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience.MethodsDatabases MEDLINE, PsychINFO, CINAHL, EMBASE and AMED were searched from earliest date available. Additional studies were identified by searching of reference lists and citation tracking. Two reviewers independently applied inclusion and exclusion criteria. The quality of each study was rated using the Medical Education Research Study Quality Instrument. Data were extracted on effectiveness of care (process of care and patient health outcomes) and patient experience.ResultsSeventeen studies across multiple health professions (medical (n = 4), nursing (n = 7), allied health (n = 2) and combination of nursing, medical and/or allied health (n = 4)) met the inclusion criteria. The clinical heterogeneity of the included studies precluded meta-analysis. Twelve of 14 studies investigating 38,483 episodes of care found that clinical supervision improved the process of care. This effect was most predominant in cardiopulmonary resuscitation and African health settings. Three of six studies investigating 1756 patients found that clinical supervision improved patient health outcomes, namely neurological recovery post cardiopulmonary resuscitation (n = 1) and psychological symptom severity (n = 2). None of three studies investigating 1856 patients found that clinical supervision had an effect on patient experience.ConclusionsClinical supervision of health professionals is associated with effectiveness of care. The review found significant improvement in the process of care that may improve compliance with processes that are associated with enhanced patient health outcomes. While few studies found a direct effect on patient health outcomes, when provided to mental health professionals clinical supervision may be associated with a reduction in psychological symptoms of patients diagnosed with a mental illness. There was no association found between clinical supervision and the patient experience.Review RegistrationCRD42015029643.
Highlights
To ensure quality of care delivery clinical supervision has been implemented in health services
Two studies found that patients managed by mental health professionals who participated in reflective practice, had a lower severity of psychological symptoms than patients managed by unsupervised professionals [22, 23]
The effects of clinical supervision on patient health outcomes and patient experience were investigated by six and three studies respectively, which was less than the 14 studies that investigated the impact of clinical supervision on performance of process of care
Summary
To ensure quality of care delivery clinical supervision has been implemented in health services. While clinical supervision of health professionals has been shown to improve patient safety, its effect on other dimensions of quality of care is unknown. The purpose of this systematic review is to determine whether clinical supervision of health professionals improves effectiveness of care and patient experience. Rationale/objectives As part of the process of ensuring quality of care, clinical supervision has been widely implemented throughout health services [1,2,3]. For the purpose of this systematic review clinical supervision was defined as ‘the provision of guidance of clinical practice for qualified health professionals by a more experienced health professional’ [1, 2, 4]. Care that is clinically effective refers to providing beneficial interventions at the right time to the right patients, and includes measures of process and patient health outcomes; care that is safe reduces and controls the risk of patient harm; and the patient should be the focus of health care intervention to ensure that their experience is tailored to their needs [6]
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