Facilitative* Supervision“ a process implemented by many

parties…” Together!

What is supervision?

The process of “directing and supporting staff

so that they may effectively perform their duties.”1

What is Facilitative / Supportive Supervision?

A process that promotes quality at all health system levels by strengthening relationships, focusing on identification and resolution of problems, and helping optimize the allocation of resources.2

Supervision: essential functions

Management, education, and support

Set objectives / expectations Monitor performance / provide feedback Ensure supplies Address training and development needs Solve problems jointly Motivate and support providers to improve

performance

Why supportive supervision?

MAQ/ program review for RH in developing countries:

Evidence from the past two decades: need to change not only the frequency, duration and structure of supervisory encounters, but also the nature and objective of supervision to make it more supportive and facilitative.2

US / UK literature review on post-graduate medical education and clinical practice:

Single most important factor associated with better supervisory or performance outcomes was the quality of the supervisory relationship.3

Supervision process1

Plan

Review

Revise

Do

What is Supportive Supervision?

Involves multiple parties Leadership team External supervisors Facility quality improvement (SS/CQI) teams Peers Community committees

Focuses on the results of processes and program outcomes (data-driven)

Fosters relationships and teamwork

What is Supportive Supervision?

Facilitates a culture of communication and problem solving

Monitors individual performance against expectations

Lessons learned for using supportive supervision

Top management must be committed

Requires motivation on the part of supervisors and staff alike

Takes time and investment to establish

Should be integrated into the existing HRM system, not as a parallel system

Lessons learned

Requires simple, short, locally appropriate and tested tools

Some decision-making authority must be decentralized

References

1. Marquez, Lani and Linda Kean, “ Making Supervision Supportive and Sustainable: New Approaches Problems”, MAQ Paper no. 4, 2002; USAID.

2. Kilminster S.M. and Jolly, B.C. (2000). Effective supervision in clinical practice settings: a literature review. Medical Education, 34, 827-840.

3. Rowe K Alexander, Don de Savigny, Claudio F. Lantana, Cesar G Victora, “How can we achieve and maintain high-quality performance of health worker sin low-resource settings?” the Lancet August 9, 2005

4. D.K. McNesse-Smith, “The Influence of Manager Behavior o Nurses’ Job Satisfaction, Productivity, and Commitment,” Journal of Nursing Administration vol. 27, no. 9 (1997): 47-55.

5. Barkauskas, Violet, H. “Perspectives about and Models for Supervision in the Health Professions”, University of Michigan, nd.

6. Coles, Tom, “Evidence-based Supportive Supervision for Health Workers: a practical system for improving family planning services”, unpublished internal document, John Snow, Inc, October 2005.

7. Walsh, K. et al (2003) Development of a group0 model of clinical supervision to meet the needs of a community mental health nursing team. International Journal of Nursing Practice, 9, 33-39.

8. Loveinsohn, B.P., ET Guerrero, S.P. Gregorio, “Improving Primary Health Care through Systematic Supervision: A Controlled Field Trial,” Health Policy and Planning vol. 15, no. 3 (1984): 112-120.

CONGRATULATIONS!