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06th July 2016

Hearing Users' Views in Supervision

The Joseph Rowntree Foundation have recently published a report that tries to highlight what it is service users want out of a mental health service. It is called Shaping Our Lives and can be viewed at: Shaping our Lives. The report is the result of a survey into what mental health service users think of the service they get, and the way that professionals interpret and work with their problems. The report is geared to influencing policymakers, but it also got me thinking about how service user views influence our way of working, and how that might be achieved through staff supervision.  Supervision is a way of ensuring we provide an effective service – but could we make it more effective by incorporating the views of service users? That’s what I want to write about in this blog.

Why supervision works

First of all why do we have supervision? You see lots of adverts for jobs saying supervision is offered, there are inquiry reports and case reviews where lack of supervision has been a criticism, so supervision is a good thing – yes, but we need to know a bit more about why it’s a good thing.

Now is poor supervision better than none? I don’t know, but neither is helpful!  Effective supervision is what we must strive for and I think it must be about making for a better and more effective worker, who will produce better outcomes for the people they work with. We’ve not time in this article to explore why good supervision works, but often the simplest way to think about this is to think about what happens to our work if we’re not supervised! I wrote an article recently about supervision in which I included a diagram of the relationship between service user and worker, and worker and supervisor – so here I want to think about how we get the service user’s issues into the supervision session. It can also be a way of the supervisor assessing the quality of the relationship between the worker and the service user, or even considering whether the service user would be better being allocated another worker, if the relationship really isn’t working.

Getting an agenda

So in thinking about the components of supervision, we need to incorporate all aspects in our supervision agenda (yes, supervision sessions should have an agenda!) You see if supervision is all about instruction, or completing forms such as audits and appraisals, handing in your leave sheet, and other tick box or administrative functions, then we miss out on many other important means for the worker to share concerns. However, if it’s all about the worker’s worries, or cases causing concern, the supervision session is dominated by managing problems and workers’ anxieties and general firefighting. One useful guide to a supervision session can be to imagine the service user, or a group of service users were listening in – what would they think? Would they be impressed? I’m sure service users would want workers to have supervision, but what would they think of the content? Interestingly enough the Social Care Institute for Excellence (SCIE) have undertaken an inquiry into service user involvement as part of a wider project on supervision, and found that many service users were not aware that workers received supervision and I’ll say a bit more about that inquiry later.

Making voices heard

Let’s think about ways in which we can get the service user perspective in there, so we can really focus on improving outcomes. Tony Morrison’s manual Staff Supervision in Social Care (Morrison T. 2005 p. 176-7) describes how supervision that focusses on user experience can work. So in planning a supervision session, supervisor and worker need to think about how the user experience can be heard. Here are some examples:

  • If you are a supervisor try and maintain a user–focused approach
  • Incorporate service user appraisal of the worker
  • Make use of service user care plans in supervision and refer to how service users identify problems, their strengths and how they want to achieve goals
  • Have meetings with a group of service users to gain their views
  • Gather feedback from service users in the form of questionnaires, or feedback forms
  • Think about how service user views can be used in planning services generally
  • Use research evidence from national surveys about service user views – it doesn’t all have to be the voices of the users you work with
  • Ensure supervisors have training in supervision, and supervisees should also have training in what they can expect from supervision

Obstacles in the way

Now all of this can sound idealistic – but there are barriers to this kind of thing happening consistently and we need to be aware of these. These were some of the issues that were picked out in the SCIE inquiry.

  • Some service users may not be able to give their views, perhaps because of mental health reasons, or communication difficulties, so it may only be a certain group of service users whose views we incorporate.
  • There is a power relationship here, one between worker and supervisor, and the other between service user and worker. Service users may not want to comment, they might think an adverse comment will somehow count against them and might damage the relationship with the worker or mean they get a worse service, not a better one!
  • Some service users who are subject to mental health law are service users not out of choice. It doesn’t mean we should not listen to their voices but they may have little choice about the service they receive!

Finding the evidence

One final issue, what is your evidence of having undertaken user-focused staff supervision? First of all that means having a supervision policy and you’ll find guidance on that in the QCS policies. Next it means a supervision agreement with your staff, and those should be individual agreements. You might have a template but adapt it for each member of staff. There’s a few more things we could include in there that might be part of the written evidence – staff supervision histories, and agendas for supervision sessions and how those agendas include the service users’ views. All the components of supervision agreements might be a subject for a future article.

David Beckingham - QCS Mental Health Specialist



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