Incidental Supervision

Garden metaphor: the big stuff, planning and planting; the small stuff, get home and do theweeding while the kettle boils.Why incidental supervision?Workshops at Forums and ICMI often mention the importance of follow up after trainingsessions to maintain and develop skills.How to develop in the moment learning, just in time learning. This is powerful learning. Forme this is in the nature of the work and is something I’ve been thinking about: how todevelop the staff I work with, embedding it into the work day and build their capacity ‘on thefly’, and fostering a learning environment.

The CLEAR modelContractListen Explore Action ReviewHawkins and Shohet 2007Listen Explore Action Review: bread and butter MITalk about contracting because this is where there’s an important difference between formaland informal supervision

In place of a contract...How do you get the benefits of a contract in a corridor conversation? A contract is there tomake sure that the arrangement is of mutual benefit. We need contracts because insupervision as in life, relationships often have marked power disparities. A contract with yourlandlord is there to stop someone with power and property making you homeless - but it alsoensures your landlord gets paid. In supervision there is often an institutional powerdifferential, particularly if the supervisor is also the line manager

What's the connection that needs to be made?This is a key question for all forms of supervisionOther forms of connection: between ideas (general and specific, this patient and that patient,an old skill and a new opportunity to use it, a feeling and an action), but also between people.Relationships are at the core of good supervisionThe connection: firstly, between ourself and the supervisee. How do you connect with thesupervisee? Ask permission.Use a competency model

Denial or lackLack ofLack ofThe superviseeof insightknowledgeskilldoesn’t careProvideProvideTeachShame theinsightfactsnew skillssuperviseeThis is why the MI mindset is important, because coming from a strength/competency basedstandpoint helps protect the supervisee. We want a learning opportunity not a hit and run.

Denial or lackLack ofLack ofThe superviseeof insightknowledgeskilldoesn’t careA sense ofKnowledge isThe superviseeprofessionalwithin thehas transferableThe superviseecuriositysuperviseeskillsis motivatedCultivateEvoke theEvoke skills toEnhancecuriosity, seek thesupervisee’sreflect on themsupervisee’ssupervisee’sknowledgeand generalisesense of selfinsightstheir scopeefficacyUsing a competence model builds safety

Use a competence modelAsk permission‘Interpret’ with care

Be the superviseeTechniquesListenDon’t do itAsk permissionPrivilege enquiry as primary interventionMove from particular to general to particularFocus on valuesAffirm and validateLook after the process and the content will(almost) look after itselfFirst listen for the opportunity, then listen for the purpose, the connection that needs to bemade.The skill in doing this is to highlight what seems to be important to help the supervisee sortunstructured impressions into a more coherent understanding of the patient.

JudgementPraise: judge an action from aposition of authorityImpactDescribe the action and your positiveresponseObservation‘Skill spotting’: describe the action andidentify the skill being usedThree types of affirmation.

ListenEvaluateTimingPermission‘LET PEARL’ExpandActionReviewLearning

Incidental and formal supervisionGardening: main events of planning and planting. The little moments between the mainevents.So formal supervision is the main event, this is about the small moments that support thelarger project of professional development.Reference: Undrill (2012) Opportunist Supervision in Owen and Shohet Clinical Supervision inthe Medical Profession (McGraw Hill, due out Nov 2012)

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