providing ‘value’ in clinical supervision how an ounce of prevention is worth a pound of cure...
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Providing ‘value’ in clinical supervision
How an ounce of prevention is worth a pound of cureTracey Tay
Staff Anaesthetist HNE HealthClinical Lead NSW Agency for ClinicalInnovation
June 11, 2014
Key messages
• Clinical supervision is essential work and it takes a lot of time and energy to do this well
• When a trainee is in difficulty, the longer the problems are left unaddressed, the more work is required
• Creating a healthy workplace helps to prevent problems and allows early detection of trainees in difficulty.
A question of attitude…..
A question of attitude
Difficult traineesvs
Trainees in difficulty
Value
• Many definitions
• Prof Michael Porter, Harvard Business School• Value-Based Healthcare Delivery
• Value = patient outcomes per dollar spent
What is ‘value’ in supervision?
• Trainee supervision outcomes per resource expended
Trainee supervision outcomes
• For the trainee₋ Knowledge₋ Skills₋ Behaviours
• For patients and the organisation₋ Safety₋ Appropriate care₋ Efficiency₋ Timeliness₋ Patient-centred care
What are we concerned about?
• Performance
• Conduct
• Impairment
• Grey areas ₋ Professional behaviour₋ Exam preparation₋ Motivation
How do we measure these outcomes?How do we know if a trainee is in difficulty?
For the trainee• Exams – formative, summative• Workplace-based assessments₋ Direct observation of
procedural skills (DOPS)₋ Mini clinical evaluation exercise
(Mini-CEX)₋ Multisource feedback
• Informal discussions with the trainee or other staff
• Informal observation
For patients/organisation• Adverse events• Complaints
Trainee in difficulty
• Rotated away on a number of occasions• Corridor and tea room conversations• “Odd behaviour”, “no insight”• Comments by nurses and other team members• 8 yrs into the program, dept decided to act• Difficult conversation• 6mth remediation program –extra supervision, extra
teaching, formal documented feedback• Trainee not reemployed
Trainee in difficulty
• How fair was this for the trainee?
• Would there have been a different outcome if there had been early intervention?
Early or late?
Early or late?
Intervening early - Coach or referee?
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Time (Quarter years)
Intervening early – feedback conversations
• Daily!• More likely to be specific, timely• Seek training in giving and receiving feedback• Provide a template to get everyone started
Intervening early – a healthy workplace
• Leadership, role-modelling and being accountable₋ Heads of department₋ Supervisors of training ₋ Clinical supervisors
• Processes₋ Clear requirements/criteria for supervision₋ Rostering for appropriate supervision₋ Workload/hours of work
Intervening early – a healthy workplace
• Support structures/people/processes₋ Orientation₋ Peer support/buddy systems₋ Mentors₋ Agreed ‘above and below the line’ behaviours₋ Support for ‘speaking up’₋ Training₋ Early access to specialist help
Intervening early – a healthy workplace
A plea for kindness and compassion
Best ‘value’ in supervision is early intervention
• Spend time and effort to create a healthy environment
• Make giving and receiving feedback an ‘everyday’ thing
• Don’t wait for trainees to make a mistake before you intervene
Remind yourself, if things aren’t going well, this is a person in difficulty NOT a
difficult person
