Abstract
BackgroundAfter widely publicised investigations into excess patient deaths at Mid Staffordshire hospital the UK government commissioned reports from Robert Francis QC and Professor Don Berwick. Among their recommendations to improve the quality and safety of patient care were lifelong learning, professional support and ‘just culture’. Clinical supervision is in an excellent position to support these activities but opportunities are in danger of being squeezed out by regulatory and managerial demands. Doctors who have completed their training are responsible for complex professional judgements for which narrative supervision is particularly helpful. With reference to the literature and my own practice I propose that all practicing clinicians should have regular clinical supervision.DiscussionClinical supervision has patient-safety and the quality of patient care as its primary purposes. After training is completed, doctors may practice for the rest of their career without any clinical supervision, the implication being that the difficulties dealt with in clinical supervision are no longer difficulties, or are better dealt with some other way. Clinical supervision is sufficiently flexible to be adapted to the needs of experienced clinicians as its forms can be varied, though its functions remain focused on patient safety, good quality clinical care and professional wellbeing.SummaryThe evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions. Among supervision’s different forms, narrative-based-supervision is particularly useful as it has been developed for clinicians who have completed their training. It provides ways to explore the complexity of clinical judgements and encourages doctors to question one another’s authority in a supportive culture. To be successful, supervision should also be professionally led and learner centred rather than externally imposed and centred on institutions. I propose that regular clinical supervision should be a professional requirement if the quality and safety aspirations of Francis and Berwick are to be met.
Highlights
After widely publicised investigations into excess patient deaths at Mid Staffordshire hospital the UK government commissioned reports from Robert Francis QC and Professor Don Berwick
Summary: The evidence linking clinical supervision to the quality and safety of patient care reveals that supervision is most effective when its educational and supportive functions are separated from its managerial and evaluative functions
Among supervision’s different forms, narrative-based-supervision is useful as it has been developed for clinicians who have completed their training
Summary
A working definition of clinical supervision If clinical supervision is to be recommended, we need some clarity about what it entails. [We define clinical supervision as] The provision of monitoring, guidance and feedback on matters of personal, professional and educational development in the context of the doctor’s care of patients. Because narrative supervision depends on the quality of the questioning, rather than clinical knowledge or experience, senior clinicians can act as supervisees as in Schwartz rounds and one to one, peer supervision as described above They can model uncertainty, ethical difficulty, emotional impact, the desire to learn from others and a willingness to be questioned [17]. Clinical supervision was carried out in groups of four or five nurses for an hour and a half each week, was learner centred, educational and supportive It had no evaluative or managerial functions. The author(s) declares that he has no competing interests
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