Supervision

Session 1: Supervision Basics

Welcome to the first self-study session in the Supervisory Training course. In this session you will learn about how supportive supervision is defined and used at Zim-TTECH, and what the main responsibilities of the role are.

Getting Ready For This Session

  • Remember to have your workbook and a pen or pencil handy.
  • You will need about 75–80 minutes to complete the session.

Learning Objectives

By the end of this session, you will be able to:

  • Define the concept and principles of supportive supervision within Zim-TTECH
  • List the qualities of an effective supervisor
  • Describe activities of supportive supervision
  • Explain the role of the supervisee within supportive supervision
  • Describe the documentation responsibilities of supportive supervision

Learning Activities

  • Pre-Session Assessment (5 min)

    Let’s start off with a quick check of your knowledge and comfort about supervision. Each question will have a score for you to track in your workbook. Please track your scores as you go through this assessment and make note of any content areas that you answered incorrectly. This exercise will help in identifying gaps and areas that need more attention as you go through the session content.

    1Which of the following words describe supportive supervision? Select all that apply.

    2Which of these essential skills must a supervisor have? Select all that apply.

    3Which activities should supportive supervision focus on? Select all that apply.

    4The supervisee’s role in supportive supervision includes self-assessment and providing feedback to the supervisor.

  • Reflecting on Supervision (5 min)
    Supervision

    We have all received supervision at some point in our lives. For example, as employees we have been evaluated and given feedback, and as students we have received guidance from instructors. You may have also had an opportunity to serve as a supervisor or a mentor, or maybe you have children of your own whom you supervise daily. These examples of supervision have a common goal—providing oversight, guidance, and support for optimal performance.

    Take a moment to visualize an ideal work setting, in which team members work together effectively and deliver service impeccably. Visualize documentation being thorough and clear. Clients are satisfied and maintain good health habits. Team roles are clear. You recognize that you as the supervisor have played a part in creating this ideal setting.

    How do you feel when you see this? Write your thoughts in your workbook.

  • Defining Supportive Supervision (5 min)

    A number of sources have described concepts that comprise supportive supervision.

    The following text from the World Health Organization (WHO)1 aligns well with Zim-TTECH's definition of supportive supervision.

    "Supportive supervision is a process of helping staff to improve their own work performance continuously. It is carried out in a respectful and non-authoritarian way with a focus on using supervisory visits as an opportunity to improve [the] knowledge and skills of health [care] staff. Supportive supervision encourages open, two-way communication, and building team approaches that facilitate problem-solving."

    In a 2019 document, UNICEF2 listed some key components of supportive supervision:

    • Understanding of roles and expected contributions
    • Teaching with praise, recognition of positive contributions, guidance on how to handle difficult situations, and an approach that uses a circular feedback loop to provide skills, tools, and solutions to overcome problems

    The role of the supervisee is described in a USAID3 paper as:

    • Being part of the team responsible for quality
    • Monitoring their own performance
    • Participating in decision-making
    • Being motivated to change behaviours when needed

    You may have experienced other types of supervision or oversight, such as:

    • Top-Down: In this model, supervisors are the final decision-makers. They create the strategies and goals, and delegate tasks without input from the actual team. This style is sometimes called ‘autocratic’ or ‘authoritarian’ supervision. Oversight from funders or government is often provided through a top-down approach.
    • Laissez-faire: In this model, supervisors give little or no oversight and guidance to their supervisees. Instead, staff are encouraged to solve problems themselves.
    • Democratic: In this model, supervisor and supervisee share the task of decision-making. Supportive supervision is based on this style, which encourages staff to offer suggestions and take initiative.
    • Bureaucratic: This model emphasizes rules and regulations that are strictly adhered to. It typically involves a framework and checklists to follow relying on consistency and adherence in clearly identified areas of focus.

    Although it is good to be aware of other models, in this training we will be focusing on supportive supervision and how it is practiced at Zim-TTECH.

  • Supportive Supervision Activities (5 min)
    Mentoring

    Supportive supervision provides an opportunity for reflection on performance. It should be conducted in a safe, conducive environment that allows for the sharing of objective feedback between supervisor and supervisee.

    Supportive supervision is focused on:

    • Effectively building the relationship between supervisor and supervisee through communication, exchange of information and feedback
    • Establishing individual and team goals
    • Monitoring and evaluating performance
    • Improving performance through mentoring, teaching, coaching, and providing regular follow-up
    • Identifying and addressing problems
    • Assuring complete and accurate documentation

    Each of these activities will be covered in more detail as you move through the sessions of this training.

  • Functions and Responsibilities of a Supervisor (7 min)

    As a supervisor, you are responsible for many tasks and functions. Listen to Alleta Makotore as she talks about the responsibilities of a supportive supervisor.

    Transcript

    Transcript
    image of Alleta

    As a supervisor, you are responsible for defining how supervision is going to take place. You are responsible for setting the objectives of the supervision. Most importantly, you want to establish a mutual relationship with the individuals or teams you work with. As you are working with professionals, you need to respect them, and acknowledge the experience that they have had and are bringing to the team.

    Remember, you are working with people with diverse backgrounds who have been working elsewhere where they may have gained some knowledge and experiences that are going to be beneficial to the supervision itself, so value whatever experience they are going to share. So it is important to give them the opportunity to also share what they already know—this way you will also be able to dispel some myths and misconceptions based on what they already have. Overall, you want your team to feel respected and valued and that will impact the work environment and culture because once someone feels they are not being recognized/they are not valued, they will lose confidence, they will not be interested in the whole process so it is important for them to feel respected, for them to feel wanted in that supervision relationship.

    Another responsibility that a supervisor has to take on is to define the boundaries for the kind of relationship you will have with your supervisee. This includes even agreeing on how you are going to address each other, the parameters in which the supervision is going to take place—are you going to relate as supervisor-supervisee at work and then in social circles how are you going to make sure that you don’t encroach into each other’s lives even outside the supervisory relationship? It’s also important to set parameters on how you will relate and communicate with each other. Like I said, it is important for you to agree on how you are going to address each other.

    Even the way you communicate feedback is very important, as you want to provide balanced and objective feedback without personalized attacks. I normally want to say that feedback should be given in a sandwich: feedback, for it to be accepted, when you are giving feedback you start with something positive that you have observed; you highlight what needs to be corrected in very clear and unambiguous terms; and then lastly you also end your feedback by also highlighting the positive. So in other words you are saying “I see that you are working very well, you are doing very well. This is really commendable but however there is this that needs to be corrected. But overall you are doing well.” That way the feedback is going to be accepted rather than just focusing on the negative or on what needs to be improved.

    When it comes to community information, as a supervisor you are responsible for updating your team on relevant information and changes to new practices and recommendations in your field so in other words you must keep abreast of all the new trends and the new guidelines that are coming on board so that you are also not embarrassed when your team asks and you keep on saying “I don’t know, I have to check.” But yes it is also good if at that moment you are not in the picture or you don’t have the information to say “I will go and consult and give you feedback.” But overall you must be knowledgeable, at least about the key policies and guidelines within your field. You can rely on this information during supervisory visits.

    And it is essential for you as the supervisor to be one making appointments with the individual or team before you arrive. The team maybe can also make adjustments to your suggestions to say that “we have this appointment on this date but we have to make changes because of some developments” —you are allowed to do that. You want to make sure, that there is minimum disturbance to the flow of work when you visit. So your supervisory visit should not disrupt the work, especially the clients that are coming to access services, they must not be inconvenienced by this supervisory visit. If for any reason you have to mix with any clients or you have to disrupt the flow of the clients, you must apologize and explain to the clients what you are doing and why you are doing what you are doing.

    Finally, your team will have questions, and like I said, as a supervisor you must keep abreast with latest information and guidelines, be knowledgeable and make yourself available to provide that support either physically or virtually. You must also have an open-door policy and be approachable. And in this regard you must never instill fear in your supervisee as this will have a negative impact on your working relationship and will hinder the supportive supervisory process, especially if it is the first visit and you instill fear. They say first impressions last long and this will actually go a long way and this might make future supervisory visits impossible.

    Alleta
  • 'What I have learned...' (10 min)

    Using your own experience as a supervisor (or supervisee), list a few examples in your workbook of when you felt that supervision went well. What was the context? What elements stood out as contributing to the positive experience?

    Have you had an experience that you felt the supervision did not go well? What elements stood out as contributing to the negative experience?

  • Essential Supervisory Skills (10 min)

    In your reflection, you may have considered how good supervisors possess a variety of skills and qualities. Let us take a look at an overview of these essential skills; subsequent sessions will cover each of these in-depth. Tap on the boxes for a description of each skill.

    Help Staff Grow

    Professional development is important for staff motivation and satisfaction. As a supportive supervisor, you will work with individual staff and teams to identify their strengths and those areas which they need to improve. Your role is one of collaboration, empowering individuals, and providing opportunities for growth. In this way, your work as a supportive supervisor benefits individuals, teams, facilities, and clients.

    Performance Management

    As a supportive supervisor, you should continually review performance to identify performance problems and issues in order to resolve them quickly. When you identify areas for improvement, you will need to collaborate with the team to develop an appropriate plan to improve performance.

    Time Management

    With different sites and issues commanding your attention, to be an effective supervisor you must be able to structure your workload to ensure that all clinical sites and problems identified are given the proper priority. You need to be able to juggle competing timelines and meet goals, especially high-priority goals. Always set an example by being punctual, meeting deadlines, and explaining delays when they occur.

    Interpersonal Skills

    Developing and maintaining good relationships with team members is very important. As a supportive supervisor you want to create an environment that fosters productivity, openness and approachability. Staff members must be able to reach out to you without any fear of being reproached or punished for sharing their honest thoughts. You should have excellent communication skills to actively listen and provide feedback using clear, unambiguous language to ensure that your message has been understood. It is also important to show respect to supervisees, peers, partners, funders, and ministry staff.

    Understanding of Systems

    The supportive supervision relationship exists within the context of the health care system. Thus, part of your role is to work with individuals and teams to identify ways in which performance is impacted by systemic factors, such as clinic flow or external community factors. In collaboration with your supervisees, you evaluate processes and come up with ways to improve performance.

    Leadership skills

    A supervisor should be able to demonstrate leadership through their ability to inspire others, share the vision of the programme, manage change, be confident and show mutual respect.

    Documentation

    Complete and accurate documentation is a crucial, ongoing aspect of supportive supervision. This relates to your own documentation of your supervisory encounters and activities, as well as to your role in guiding and monitoring high-quality documentation by your supervisees. One of the mottoes that has been stated in our program is, ‘If it wasn’t documented, it wasn’t done.’

  • Benefits of Supervising (5 min)

    After learning about the responsibilities and functions that comprise supportive supervision, it can feel daunting. However, supervising has many benefits such as growing your own leadership and interpersonal skills. Let’s listen to Alleta as she explains what has kept her motivated as a supervisor for more than 21 years.

    Transcript

    Transcript
    image of Alleta

    So over the years I have learned that the supportive supervision encounter is not just a one way process where the supervisee is treated as an empty vessel and the supervisor assumes the role of information, but rather, it is an opportunity for me to learn new things even from my supervisee who, by virtue of being adults, they bring lots of valuable experiences that they have acquired over their lifetime. And once you have acknowledged those experiences, you make them feel important. You tap on those experiences, learn new things that you may not be aware of. I also get great satisfaction from capacitating team members and seeing them grow because of my own contribution.

    For example, after giving an individual or team a task during a supervisory visit, going back to see progress made on the previously identified gaps makes me realize the fruit of my work, the tangible benefits of working with individuals and teams, thus having a sense of relevance in my work.

    And I really feel satisfied—I see something that is tangible that I have done through my supervisory work. As a supervisor I continue to grow both professionally and in leadership skills and also even in social skills because I also have the opportunity to interact with my supervisees.

    Tapping on those experiences that I talked about, for example, during feedback, by the way—it is not just the supervisor who is expected to give feedback—you must also be open to feedback from your supervisee, because when you receive feedback for example on some negative aspects which I would not be aware of, and I would use that experience to correct and improve myself. You must also not be defensive but be receptive and accept that feedback. You really find that supervisees can be objective enough to say “I think if you do this our supervisory relationship would be more beneficial” or maybe “you need to approach this…”, they will suggest on ways on how to approach certain things, how to relate, and that feedback is very important. You use that to build on your skills as a supervisor without being defensive.

    And finally, there are times when I face challenging situations as I carry out my supervisory roles, I may have some gaps in knowledge, supervisees may raise issues that I may not be able to respond to, that I might not have answers immediately, and this would prompt me to go and research, and in the process as I research I get new ideas, and thereby improve my leadership skills and have more knowledge about certain issues. So this must be a two-way process where you are also benefitting from what the supervisees know or have.

    Thank you.

    Alleta

    As Alleta has shared, there are personal satisfaction and growth opportunities available to a supervisor. Additionally, your skills in supportive supervision can benefit others through:

    • Improved performance of individuals, teams, and facilities
    • Improved coordination and shared vision by team members
    • More efficient service delivery
    • Client satisfaction
    • Improved client outcomes
  • Documenting Supportive Supervision (5 min)
    Documenting

    Supportive supervision is part of routine and targeted management practice. In Zim-TTECH, all interactions can employ the supportive practices being taught in this training. Learning can happen anywhere at any time with anyone. When problems arise, support will be more targeted to focus on the issue at hand.

    Documentation should be structured into your day so that details are still fresh in your memory, and you can be accurate in what you are recording. If you fall behind, it becomes overwhelming and harder to do, and less accurate.

    Regularly doing your documentation also serves as a model for your supervisees. You may wish to show your supervisees how you complete your paperwork, and ask them what their process is. Keep the subject of documentation alive with your supervisees.

    Refer to and make use of your documentation regularly—doing so will help you improve your ability to do your job, as it will keep your memory fresh.

    Recommendations from our expert supervisors include:

    • The supervisor must never leave a facility without documenting key findings and observations, and agreeing on recommendations or a way forward. This is critical, as it informs the direction to be taken during subsequent visits, when the first task will be to review recommendations from previous visits.
    • In addition to documenting findings in the visitors log, the supervisor should also have their own notebook in which they document key findings from the visit.
  • Role of the Supervisee (3 min)

    Your supervisees play a critical role in the supervision relationship/process. In Session 2, we will talk about how effective communication helps to facilitate the exchange of feedback between supervisor and supervisee. The supervisee should be actively engaged in the process.

    • The supervisee assesses their own skills and knowledge gaps and seeks assistance as needed.
    • The supervisee receives and accepts supportive feedback from the supervisor.
    • The supervisee provides the supervisor objective feedback on their relationship and the support and supervisory session.
    • The supervisee actively follows up on recommendations and works on action items according to agreed timelines.
  • Case Study: Takudzwa (10 min)

    Throughout this training we will follow a fictional case study to illustrate the concepts covered in each session. In this session, we are introducing the case study, its primary characters and their worksites.

    Introduction

    The main character we will follow is Takudzwa, who is a new District Program Mentor.

    image of Takudzwa
    Takudzwa

    Takudzwa works in the supervisory structure shown below:

    map
    Head Office team Provincial Focal Person District Supervisor Facility Staff
    Head Office team

    Provides oversight, supportive supervision, coaching and mentorship, to Provincial Focal Person

    Provincial Mentor

    Provides supportive supervision and mentors/coaches the District Supervisors

    District Supervisor

    Provides supportive supervision to the Facility Staff

    Facility Staff

    Front line working directly with clients, managed by facility management team. The team being provided support includes Nurses, Primary Counsellors, Community Linkage Facilitators, and Facility Linkage Facilitators

    Takudzwa provides supportive supervision at four facilities. For this case study we will be focusing on two of the facilities:

    • Mwenzi Polyclinic
      • Located about 15 km from the district office
      • A high-volume facility with a total of 3860 clients on ART
      • The OI/ART clinic is a standalone programme at the polyclinic with a team that includes several seconded team members:
        • Two Program Nurses-OIC and
        • Two Primary Counsellors
    • Mutorashonga Clinic
      • Located about 120 km from the district office in a rural farming community
      • A lower-volume facility with a total of 650 clients on ART
      • The clinic has a Nurse-in-Charge and one seconded Program Nurse-OIC
      • The team are often pulled into other clinical duties because of limited staff at the facility

    Initial Visits

    Takudzwa goes out to conduct his initial supportive supervision visits to the facilities. He is accompanied by his supervisor, Kuda, a Provincial Mentor (PM), and provincial and district ministry representatives.

    1What should Tadudzwa discuss with the team in his initial conversations at these site visits? Write your response in your workbook and then tap the Show Feedback button to read an expert’s answer.

  • Action Plan (10 min)

    Review the essential supervisory skills presented earlier in this session.

    Using the Action Plan form in your workbook, list 2-3 skills that you would like to improve as a supervisor. Write a few sentences about how you are currently practicing those skills, and how you would like to develop them further.

  • Post-Session Assessment (5 min)

    Now that you have completed this session, let’s take time to check your knowledge and comfort about supervision. Please track your scores as you go through this assessment, compare them with your pre-test scores, and make note of any content areas where you answered incorrectly.

    1Which of the following words describe supportive supervision? Select all that apply.

    2Which of these essential skills must a supervisor have? Select all that apply.

    3Which activities should supportive supervision focus on? Select all that apply.

    4The supervisee’s role in supportive supervision includes self-assessment and providing feedback to the supervisor.

    If you find that you have some gaps in your knowledge or understanding, think about what you can do to fill in those gaps for yourself, and what resources you can access.

  • Summary (2 min)

    Congratulations on finishing the session! We defined supportive supervision, its roles, objectives, and functions. We took time to consider the essential qualities of an effective supervisor, and you had an opportunity to reflect on your own supervision skills.

  • Resources

    Below are links to resources relevant to this session.

    Title/Source File
    Supervisory Training Workbook Click to open file.
    Additional Reading on Supportive Supervision:
    Marquez, L., & Kean, L.C. (2002). Making supervision supportive and sustainable: new approaches to old problems. Click to open file.
    Avortri GS, Nabukalu JB, Nabyonga-Orem J. Supportive supervision to improve service delivery in low-income countries: is there a conceptual problem or a strategy problem? BMJ Global Health 2019;4:e001151. Click to open file.

    Footnotes

    1. Vaccines and Biologicals Training for Mid-level Managers, World Health Organization Department of Immunization, 2008
    2. Supportive Supervision—A Manual for Supervisors of Frontline Workers in Immunization, UNICEF, 2019
    3. Making Supervision Supportive and Sustainable: New Approaches to Old Problems, Maximizing Access and Quality—an initiative of the United States Agency for International Development (USAID), 2002