CLINICLA Palestinian Health

8/14/2019 CLINICLA Palestinian Health

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Improve & unify the services for the purpose of improving the quality of careoffered for women & children.

Establish a system of clinical supervision to be applied in all MCHN clinics. Improve the performance of clinical supervisors by equipping them with

appropriate theoretical and practical knowledge towards strengthening their

supervisory skills. Advance participants analytical skills as it applies to situations from local

Palestinian context.

Facilitate and foster teamwork spirit and skills through investing in participantswon field experiences.

5. Training period: three-four days.

6. Training time: 8:30-1:30.

7. Place: the first period will be in Hebron.

8. Target Group: Doctors, nurses midwives who have the responsibilityof supervision in the primary health sectors both governmental & NGO'S, have the

desire to participate, have the time to prepare training assignments & and are

committed to create the system in their respective work setting.

9. Program outcomes

Enhance client care Encourage clinical effectiveness Promote evidence-based practice Enhance professional knowledge Increase analytical thinking Establish a consistent system to support continuing professional development Increase self confidence Enhance staff morale Support staff retention Comply with established protocols and guidelines


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Part One

Introduction to supervision

1.1 Aim and objectives of this part

After completing this session participants will be able to demonstrate a good

understanding of the concept of clinical supervision and the role of supervision in the

care delivery process.

This will be achieved by enabling participants to;

Define clinical supervision (CS) in its broadest sense differentiating betweeninternal and external supervisor.

Identify the responsibilities, role, required skills and personal characteristics ofa CS.

Describe the benefits of CS. Discuss the core of CS & its application. Develop an understanding of major CS models.

1.2 Learning methods: facilitator presentation, discussion, group work

1.3 What is clinical supervision (CS)?

A thorough scrutiny in the relevant literature revealed many definitions of clinical

supervision. The Vision for Future (1993)1, for example, identified twelve key

targets, the tenth of which is related to clinical supervision whereby it is defined as

follows:

"A formal process of professional support & learning which enables individual

practitioners to develop knowledge & competence, assume responsibility for own

practice & enhance consumer protection & safety of care on complex clinical

situations. It is central to the process of learning & to expansion of scope of practice

& should be seen as a means of encouraging self assessment & analytical & reflective

skills" (Vision for Future, 1993).

The UKCC frequently addressed clinical supervision as a key aspect of quality

healthcare. In its position statement (1996) it stated that clinical supervision is:"A process that brings practitioners & skilled supervisors together to reflect on

practice" "A process that aims to identify solutions, improve practice & increase

understanding of professional issues. Or

A process of guiding, helping, training & encouraging staff to improve performance

in order to provide high quality of health services.

Supervision is carried out by a responsible person for the performance of clinical

staff (medical officers, nurses, and midwives) in addition to non-clinical staff

(receptionist, cleaners etc).

1This definition was also adopted by Hanan Project.


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The UKCC (1996) further believes that the following key conditions will assist in the

development & establishment of effective clinical supervision:

Support practice, enabling practitioners to maintain & promote standards ofcare.

Practitioners & managers should develop process of clinical supervision. Ground rules should be agreed so that both practitioners & supervisors can be

confident & open in their approach to clinical supervision.

Clinical supervision is based upon a clinically-focused professional relationshipinvolving a practitioner reflecting on practice guided by a skilled supervisor.

An effective preparation for clinical supervision should include principles &process of clinical supervision.

Evaluation should be carried out to determine the influences on client care.1.4 Who is the clinical supervisor?

A CS is the person who is responsible for maintaining the quality of health serviceson a day to day bases(internal supervisor) or who travels to the site for periodic

supervisory visit (external supervisor).

1.5 Responsibilities of the clinical supervisor Protection of the public. Identify standards for good performance. Work with staff to assess performance vis--vis set standards.

Combine professional & practice responsibilities for changing inferior or poorpractice

Carry out clinical audit for monitoring performance. Act as a guide for the team & ensure the provision of quality service. Discuss with the team the code of their practice, clinical guidance &

evaluation & assessment tools.

Has an administrative & educational responsibility, Monitor staff levels & skills in relation to safe practice. Investigate any allegation of professional misconduct.

1.6 Clinical supervisor Criteria

Expertise: recognition may be informal through skill & experience and maycome from peers, while formal recognition is gained through status & training

and may be communicated by your senior/s.

Experience: have breadth & depth of experience in his/her field of specialty. Acceptability: should be acceptable to those he/she supervises. Training: further training & experience of supervision is considered essential

to help develop skills of both supervisors & supervisees. Update his/her skills &

knowledge through attending training courses in clinical supervision.


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1.7 Behaviors favored in supervisors after Hagler (1991) Benevolence Confident in practitioner Empathy encouragement

Positive reinforcement Promotion of client care Role modeling.

1.8 Role of supervisor Teacher: he/she responsible to determine what is necessary for the supervisee

& clients to learn. Evaluative comments are also part of this role.

Counselor: he/she addresses the interpersonal & intrapersonal reality of thesupervisee. Doing so, the supervisee reflects on the meaning of an event forhim/herself.

Consultant: allows supervisee to share the responsibility of learning.Supervisor becomes a resource for the supervisee but encourage the

supervisee to trust his/her own thoughts, insight, & feelings about his/her

work with the client.

Supervisor responsible of ensuring that work get done through state an agencyrules, regulations, & policies are fairly & equitably applied to all employees.

Supervisor is a management representatives: balance organizational needswith employee right on a daily basis.

Responsible to inform their employees about their performance.1.9 Skills required in supervisor

General skills: supervisor required to provide the right balanced of skills toenable them to be able to challenge, question & help people confront their

attitudes, believes & habits.

Communication skills: he/she should be attentively & actively, listening &being able to comment openly, objectively & constructively.

Supportive skills: to be able to identify when support is needed & offersupportive reposes. The relationship should not be a hierarchical.

Specialist skills: be oriented to specific skills.

1.10 Personal characteristics of successful supervisor after

Rogers (1983)

Approachability- experienced at being nonjudgmental & willing to listen. Openness- to new ideas, experiences, change & constructive criticism from the

supervisee.

Trustworthiness- able to keep confidences has the supervisee's best interests atheart, & not pursuing one's own agenda.


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Consistency- between wards & action. Self confidence- both as a practitioner and supervisor Self disclosure- prepared to reveal something of who they are as a person and a

professional and of their own life.

Warmth- towards supervisee. Flexibility- in style, strategies and interventions and in responding to the

supervisees needs.

Attentiveness- familiar with, listening and engaging with the supervisee. Commitment- to the supervisee and process. Supportiveness: offering emotional, practical & intellectual support. Reliability: turning up to sessions, avoiding cancellation. Congruency: being a unified person not a faced. Non defensiveness: accepts constructive criticism as useful not as threatening. Concern: cares about supervisee as a person & professional. Investment- of time & self. Self aware: consciously observing, evaluating & monitoring self.

1.11 Benefits of clinical supervision

Provides an opportunity & a forum to reflect aspects of client care that may bedifficult, & opportunity for solving problems.

Encourages evidence based-practice. Develops new knowledge, skills & values. Creates confident decision makers, which leads to empowerment & self

assurance, leading to innovative & creative practice. Improves relationship between supervisor & practitioners, & between

practitioners & clients.

Monitors the quality of care that is being delivered to supervisee's clients. Enhances the professional functioning of supervisee & ensure quality of care. Provides a forum for practitioners to demonstrate accountability. Has a potential to reduce discomfort through active management of stressors.

(Fowler, 1996; Butterworth, 1996; Palmer, 2000)

1.12 Core of clinical supervision Time & duration of CS it is emphasize on having continuity & be arranged at

regular intervals.

Professional learning & development process: continuous learning fromexperience, practice or problem solving & integration process of professional

experience, skills & knowledge.

Goals: the formal nature of CS is attained from its goals, focus & objectivity.These goals described as individually emphasis based on supervisee needs or

organizational needs.

Content: practice oriented, comprised of everyday experiences &characterized by assessing one's performance & relevant knowledge (Fowler1996). It also focuses on practice (problem related to client care), organization


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& management (division of work, team's functionality, co-operation &

collaboration), education, training & personal development.

Supervisory relationship "possible scenarios" :1. One-one with a supervisor from the same or different clinical

setting or profession

2. One-group with a supervisor from the same or different clinicalsetting or profession

3. Peer one-one/group where there is no hierarchy but differentexperiences facilitate the discussion. This is very similar to the

peer review process but tends to involve a wider focus than

review of patient notes, may involve peers that do not have a

similar background and occurs on a more frequent basis

4. Triadic one to one supervision with a third party as observergiving feedback to both

5. Network similar to peer group supervision, but where thoseinvolved do not work together on a regular basis

1.13 Conceptual models of clinical supervision

Many CS models were developed or refined by different authors. Regardless of the

emphasis of the model, all tend to encompass aspects of personal & professional

support, educational & quality assurance functions. The main argument has been that

there does not appear to be a single model of CS appropriate for all levels of staff and

all clinical specialties but that a model implemented in practice should always be

tailored for specified needs and purposes (Fowler 1996b); that is to say

contextualized.

Brocklehurst (1994) identify a number of common features in a majority of

definitions which encompasses; supportive, educational & managerial functions as

the prime elements of clinical supervision. Prior to that as developed by Kadushin

(1976), these features are:

The supervision relation is of fundamental importance. Supervision has a number of related aims including; ensuring safe practices,

developing skills, encouraging personal & professional growth & supporting

staff.

The process of supervision requires structures & procedures. Supervision is an active process necessitating equal input from supervisor &

supervisee.

Eventually, supervision models tend to fall into three major categories;

a. Growth and support models emphasizing relationships main constituents(Faugier)

b. Role models describing elements of the main functions of supervision( Proctor)

c. Developmental models emphasizing the process of the supervisoryrelationships (Page and Wesket)


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1.13.1 Faugier Growth and Support Model

Faugiers (1992) model is one of the most cited growth and support models in the

nursing literature. Faugier sees the role of the supervisor as facilitating growth both

educationally and personally in the supervisee, whilst providing essential support totheir developing clinical autonomy. To achieve this, the supervisor must be aware of

the elements in the relationship over which they are influential:

Generosity of time and commitment, as well as praise Rewarding of development and effort Openness to feelings and experiences and parallel processes Willingness to learn and develop Thoughtful and thought provoking Personal not subjected to unnecessary structure Practical focusing o practice and improvement Orientation respecting the opinions and ideas of others Relationship learning to make new and increasing use of self Trust without this there is no effective relationship

1.13.2 Proctor interactive Model

Proctor proposed three functions for the clinical supervisor. These are :

Formative

Develop skills and understanding of supervisee through educative process.

Achieved by reflective practice leading to greater understanding of clients needs and

development of self-awareness in the service of a quality outcome. The supervisee

can also examine their clinical interventions and ensuing consequences.

Restorative

A supportive process that enabling the supervisee to understand and deal with any

reactions which may result from their work stressors.

Normative

These managerial elements the quality control aspect required from those who work

with the public. The supervisor's duty bound to ensure the highest standards and

principles are upheld.

This model combines the different functions of supervisor and demonstrates how it

can focus predominately on one or other function at different times. However, the

ultimate quality of nursing work demands that the supervisor should always consider

them as interrelated and overlapping.


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Functions of Supervision as Proposed in Proctor Model

Education

OversightSu ort

1.13.3 Page and Wosket Cyclical Model

Page and Wosket proposed a model for CS that is composed of five stages. These are;

Stage 1 Contract

Underpins the entire process and relationship, provides, and supports gives structure,

direction and purpose. Re-contracting can occur at any stage and is the sign of a

healthy and growing relationship.

Stage 2 Focus

This is the subject or material under consideration. maybe some aspect of work and

develops the supervisors responsibility for making the best use of the supervision

process .It encourages intentionality (direction and purpose) and reflection and

ensures the supervisee has prepared for supervision in advance of the meeting.

Stage 3 Space

Creating space is at the heart of the supervision process and is where the supervisee is

held, supported, challenged and affirmed in their work. Movement and insight also

occurs here.

Stage 4 Bridge

This process ensures that learning and awareness from the supervision is carried into

the work situation. It may be as simple as an awareness that nothing tangible needs to

change.


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Stage 5 Review

This may take the form of evaluation or assessment; it ensures that practitioners

actively reflect upon, monitor the standard and practice of their own professional

practice.

Sources: Page, S. and Wosket, V. Supervising the Counselor, Routedge 1994.

(5)

Review

(4)

Bridge

(3)

Space

(1)

Contract

(2)

Focus

CS


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Part Two

PERFORMANCE, QUALITY, & SUPERVISION:

WHERE IS THE LINK?

2. Aim of this part

The participants will be able to demonstrate a good understanding of the link between

performance and quality on the one side and CS on the other.

This will be achieved by enabling participants to;

Understand the concept of "quality of care" conceptually and operationally. Understand the quality cycle. Develop deep understanding of 'Total Quality Management' (TQM) as the

guiding philosophy of 'Quality'. Grasp the link between performance and quality and appreciate its significance. Comprehend steps of the performance and quality improvement process. Interpret and employ 'audit' as quality monitoring instrument.

2.2 Method of training: facilitator presentation, discussion, groupwork, situation analysis, role play.

2.3 Quality of Care Conceptually & Operationally

o DefinitionsRoemer & Aguilar (WHO, 1988) define quality of care as;

"Proper performance (according to standards) of interventions that are known to be

safe, that are affordable to the society in question and that have the ability to produce

an impact on mortality, disability and malnutrition."

Institute of Medicine (1990) define quality of care as "the degree to which health

services for individuals and population increase the likelihood of desired outcomes

and are consistent with current professional knowledge".

Esselstyn (1958) stated that Standards of quality of care should be based on the

degree to which care is available, acceptable, comprehensive, continuous, and

documented, as well as on the extent to which adequate therapy is based on an

accurate diagnosis and not on symptomatology".


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2.4 The Quality Gurus

Edward DemingDeming saw quality improvement as being analogous to reduction in process

variation. Deming's approach started with understanding the causes of two types of

variation.

1. External influences on the process which he described as uncontrolledvariation due to "special causes". Examples are changes of operation,

procedures, and raw materials. All these interrupt the normal pattern of

operation.

2. Controlled variations which are due to chance, random, or "commoncauses". All of these by definition are due to the process itself, its

design or installation.

For Deming, quality improvement must begin with identification of the two types of

variation. The next stage is to eliminate the "special causes" and only then work on

the "common causes". Management improves the process by re-designing it to

improve it's capability to meet customer needs.

Deming also stressed the crucial importance of the need for a deep understanding of

businesses work processes. Without this, true progress will not be made. Over the

years Deming thoughts expanded, to cover issues of managing people, leadership and

training in order to achieve quality goals.

Joseph JuranJuran published "The Quality Control Handbook" in 1950 which became the standard

reference book on quality world-wide.

Juran developed his TQM philosophy around his "quality trilogy"

1. Quality planning: the process for preparing to meet the quality goals2. Quality control: the process for meeting quality goals through operations3. Quality improvement: the process for break through levels of performance

Both he and Deming correctly stressed the need to involve people throughout theorganisation in quality improvement but in particular that most quality issues are

down to management dealing with systems. The emphasis is on getting the system

correct rather than blaming failure on operator error. Juran particularly emphasized

the use of quality teams and training them in measurement and problem solving.

Kaoru IshikawaIshikawa is regarded as the father of the quality circle approach which was involved

in building shop floor teams.


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Philip CrosbyCrosby presented his "4 Absolutes of Quality" as the cornerstones of his approach

1. Quality is defined as conformance to requirements, not just as goodness2. Quality is achieved through prevention not appraisal3. The quality performance standard is "zero defects" and does not allow and

build in acceptable levels of errors and inefficiencies

4. Quality is measured by the price of non-conformanceCrosby spread the word that, as in the title of his most popular book, "Quality is

Free". He believes that by setting up processes that are designed to prevent errors, by

having people trained and motivated to operate them as designed, not only will quality

improve, the costs of production will be reduced.

Robert MaxwellAccording to Maxwell (1984), there are six dimensions of quality in health care; these

are:

Quality Circle after Maxwell

Quality

Maxwell, R. Quality Assessment in Health, BMJ 13, 1984, pp. 31-34.


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2.5 Quality cycle

(Steve Cottrell & Paul Gilligan 2000)

2.6 Why is Good Quality of care important?

Providing high quality health care as a basic human right is a critical elementof health care services.

High quality services ensure that clients receive the care that they deserve. Provide better services at reasonable prices which attract the clients. Provide care to all who need it equally. Can managing health problems effectively, reducing deaths & chronic ill-

health, reduce the need for emergency intervention & help prevent

overburdening of referral facilities.

Re-evaluate

Take action

to remedy

deficiencies

Monitor

performance

Identifyspecific

achievable &

measurable

standards

Decide

approach

Identify an

area for

action

Set

priorities

Quality

Cycle
mailto:[email protected]:[email protected]


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Increase the use of services, attract more clients, reduce the cost & ensuresustainability.

Improve the staff moral.

2.7 Total Quality Management (TQM)

In trying to define TQM is it is well worth considering the relevance and meaning of

gether lead to the reliable delivery of exact, agreed

,

occasion.

by

ght

and maintaining a continuous improvement

Situation I:Write down a case that you face through

your work as a supervisor for your area of

practice whe efect in yourre you find a d

staff performance, identify your action &

your method of follow up, i.e.; your

intervention. Interpret your action guided

by what you got to know in this session.

the three words in its title.

Total- The responsibility for achieving Quality rests with everyone in the institution

no matter what their function is. It recognises the necessity to develop processes

across the institution, that to

customer requirements.

Quality- The prime task of any business- certainly including that of health- is to

understand the needs of the customer, then deliver the service at the agreed time

place and cost, on every

Management - Top management lead the drive to achieve quality for customers,

communicating the institution's vision and values to all employees; ensuring the ri

processes are in place; introducing

culture.

Marking out key determinants of quality WHO (1998) states them as; technical

competence of the providers, their inter-personal skills, the availability of basic

supplies & equipment, the quality of physical facilities, infrastructure, and linkage to

other health services & existence of a functional referral system.


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2.8 Implementing TQM

(1)

Unit strategy development

(2)Communicating strategy

(3)

Clarification of Management responsibilities

(4)

Audit of existing Quality improvement activities and attitudes

(5)Quality

indicators

Stap

ndard &rotocols

Outcome

monitoring

Directorate / service area/locality

Quality planning

Quality costs

back

Staff

Patient feed

communication

and empowerment

(6)

D e seminars to raise staff awarenessirectorat

(7)

Develop Directorate Quality Management System- Process- staff empowerment improvement

- Continuous quality improvementtient responsiveness- pa

2.9 Continuous Quali p ment (CQI) involves all Staffty Im rove

Putting the customer

first

Anticipating and

knowing customer

expectations

Meeting and

exceeding customer

expectations

Getting the serviceright first time

Reducing the costs ofpoor quality

Reinforcing goodstaff performance


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2.10 What is Supervision for Performance & Quality Improvement?

Supervision for performance and quality improvement focuses on;

i) Goal: the goal of supervision is to support & promote delivery of highisor can

transform the negative impression of supervision into positive one.

et

out

ent

iii)that people work better when they actively participate

quality health services. If this goal is clearly stated the superv

ii)Process: clear step-by-step process encourages supervisor and staff to sperformance standards for their site, make sure standards are met, find

what is helping or hindering good performance, identify and implem

ways to improve performance and quality, and regularly monitor and

evaluate outcomes.

Style: inclusive of as many stakeholders as possible, achieve results

through teamwork & provides constructive & useful feedback. Theunderlying theory is

and are listened to, treated well, encouraged to do a good job and

recognized for a job well done.

Situation IIIn conducting periodic observation of clinical staff, you

find that they are not properly decontaminating their

instruments after us hey are not using the

p

n

e. Specifically, t

correct formula for mixing chemical disinfectants, and

they are not leaving instruments in the solution for the

appropriate amount of time. Assuming that they are

being careless or do not know to do this correctly, you

arrange for them to attend a 1-day course on infection

revention. After they return, you find that they still are

ot decontaminating their instruments according to the

procedures outlined in the clinic guidelines. List somepossible reasons why this problem persists. What can

you as a supervisor do to increase the compliance with

the procedure outlined in the clinical guidelines?


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2.11 Factors that affect performance: Information & communication. Environment.

.

To p e and quality

imp v

urages

ated by involving many different

stakeholders (people who have an interest in the services being provided) those

2)know their duties & how they are expected

the

3)ally on periodic basis by observing staff or

4)al performance & work with sta to

5)ance.

6)meeting the established standards? If

Motivation & inventive to perform well Organizational support.

ills, knowledge & attitude to do the job Appropriate sk

hel achieve high quality of health services the performanc

ro ement process involves the following steps:

1) Create a shared vision with stakeholders.A shared vision encoeveryone to work towards the same goal & is cre

can be; staff, community, members & leaders, government & nongovernmental

organization.

Define desired performance for the work site. Good performanceneeds from the people to know what they are supposed to do. Performance

standards need to be set; staff needs to

to perform them, desired performance goals, strategies & culture which guides

health service delivery site, as well as the perspectives of the clients & the

community it serves.

Assess site performance.Continuous assessment of how people are

performing compared to how they are expected to perform. This can be donethrough ongoing informal basis or form

getting feedback from the clients & staff.

Find causes of performance gap. You as a supervisor may find a practiceor area of performance that is exceptionally strong. Recognize this strength,

identify possible reasons for this exception ff

apply this strength to other area of practice. A performance gap exists when there

are discrepancies between the actual performance & standards that you & your

stakeholders set. So the reason for this gap should be explored with the staff and

hindrances of desired performance must be examined. Sometimes, the real cause

for poor performance is not obvious and might need time to find.

Select & implement intervention to improve performance.Once thecauses of the performance gap are determined the supervisor & the team need to

identify, prioritize, plan & implement interventions to improve perform

These interventions might be directed at improving the knowledge, skills of staff,

improving the environment or support system (supply system, management

system) that enable staff to perform well.

Monitor & evaluate performance. Once the intervention/s has been

implemented, it is significant to determine whether or not that intervention yieldedthe desired result. Did it move you closer to


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not, you will need to go back again and take another look at what is hinderin

performance to make sure that the interventions are being targeted appro

g

The Performance and Quality Improvement Process2

Small groups exercise 1: participants will apply this framework

to establish a unified approach to implement performanceimprovement process in their clinical setting.

CONSIDER

INSTITUTIONAL

CONTEXT

W

challenges faceyo site?

What does theco ct

2 Adopted from the performance Improvement framework that was developed through a collaborative effortamong members of the performance Improvement Consultative Group (PICG) In: Supervising Health Services:Improving the Performance o People. By Caiol, et al (2001). JHPIEGO Corporation.

hat resources,

strengths and

ur

What is yourmission?

mmunity expe

of you?

Monitor & Evaluate Performance

Create A Shred Vision With Stakeholders

Define

Desired

Performance

Assess

Site

Performance

Find

Causes

of Gap

Select

Intervention

to improve

pe e

Implement

Interventions

to improveGap

rformanc performance


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2.12 Putting quality into practice: Audit as an Instrument

UDIT: compare standard with practice,its objectiveis to assess strength &ment

by evaluating th nts of

tion

actions.

&

The i

prof s

nalysis of the quality

the procedures for diagnosis and treatment, the use

resulting outcomes and quality of care for the patient.

erapists etc., other than medical practitioners.

resources in

care.

ed with areas which appertain to standards that

sional practice, for example relating to acceptable

e prescription of medications (Doyal, 1992).

Aweakness of the MCHC (Maternal & Child Health Centers) quality manage

stem e effectiveness of management/technical requiremesy

quality management system, planned arrangement & evaluating the implementaefficiency.

Nothing shall be called good practice until there is evidence that it achieved &

continues to achieve the desired outcome (DoH, 1993).

The word audit in general means to examine accounts Audit is related to accountability which is to be called to account for ones Good standards do not guarantee good practice. Audit measures practice rather that provide evidence as in research. Audit ensuring that right thing is done rather than find out the right thing to

do.

It is designed to influence me not you (Nixon, 1992). Audit provide a baseline data for future audit, identify trends & to gather

information for national, health authorities, professional bodies & other

agencies.

People who audit are in fact performing an evaluation purpose to examinedevelop care to improve practice.

re s a range of audits currently in place. Medical, clinical, managerial,

es ional and consumer audits are discussed below.

1. Medical audit.

Medical audit is defined as being a systematic, critical a

of medical care, including

of resources, and the

2. Clinical audit.

Clinical audit is basically audit by professional services, such as nurses,

midwives, physioth

3. Managerial audit.

Managerial audit can be seen as largely concerned with the use of

the provision of health

4. Professional audit.

Professional audit is concern

are acceptable for profes

standards required for th


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5. Consumer audit.

Consumer audit can be said to review the quality of care provided by

health

services from the patients point of view. It establishes the patients quality

e of observation and interview techniques identifies and

defines standards of service which patients should reasonably expect, and

e ia.

Comparison result.t. (Shaw 1989, 1992).

agenda through a rang

measures performance against those standards (Dennis, 1991).

2.13 Requirement for audit:

Explicit criteria for good practice. Objectives measurement of performance. Cas s selected or using agreed criter Identification of corrective action.

Documentation of review procedures resul


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2.14 Stages of audit

IdentifyTopic and

Audit team

Identify

necessary

changes

and agree

Sustainchanges &

re-audit

Agreestandards

and

criteria

Select

sampleand collect

data

Analyze

data andcompare

results with

Stages of Audit

an action

standards


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Part Three

Supervision and Performance

3.1 Introduction:pervisor to identify the desired performance through setting

reasonable, observable and measurable performance standards which help in guiding

formance standards & gain skills in

using the assessment tools that are considered important for the supervisor.

Define performance standards and its benefits.

s.

of their supervisees.

p

work, situation analysis.

.4 P means the level of performance required to obtaina desired outcome.

1. The staff will know exactly what is expected from them to do which helpsetter work.

3. h expectations have been met.

It is important for the su

the rest of the work. Once the standards stated it become the responsibility of the

supervisor and the team to assess the effectiveness of those standards.

3.2 Aim and objectives of this partThis part will concentrate on how to state per

This will be achieved by enabling participants to:

Identify sources and means for setting standard Practice their role in improving the performance3.3 Method of training:facilitator presentation, discussion, grou

3 erformance standards

3.5 Benefits:

them to do b

2. Protect the public by establishing criteria to maintain and improve services.Assess the extent to whic

4. Provide staff with clear and achievable targets against which to measureprogress.


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Situation IV

You are giving feedback to a new staff

member who continues to leave importantsections on the client record card blank. The

staff member responds by saying The

person who showed me how to do this told

me I only need get the clients name and

number of children they had. Are you

saying I need to fill in all the blanks? What

would you do to clarify your expectations to

3.6 Sources of Performance StandardsInternational (example is listed in Appendix ?)National (example is listed in Appendix ?)

Job description (an example of job description is in Appendix ? that facilitate the

participants knowing the main components of job description.

3.7How to set standards for the worksite Determine priority areas Identify and obtain the various resources that are available to help you set the

standards.

Work with your staff to create and adopt appropriate standards for yoursituation.

3.8 Criteria of standards that you need to look for: Kemp and Richardson(1990) state the following about standards:-

Realistic means they can be achieved Measurable means capable of expressing a result Appropriate for the patient population for which it will be applied Desirable and Acceptable - for the above reasons and to ensure it does not

offend against culture, professional ethics, policies or procedures


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Unambiguous must have clear meaning, leaving no room for doubt, using thecorrect words.

3.9 Supervision & Performance Assessment

Appendix (

Situation V

You have worked with staff to strengthen site

standards and feel that they now represent

the level of service that your clinic should be

providing. In conversations with staffsomeone suggests looking at whether the

new standards are being met. The question

is then asked What and how should be

assessed to see if we are meeting our

standards? How would you respond? Write

your responses.

Question one: What to assess?

In order to find out how your site is doing you need to periodically assess variousaspects of the care within your facility, including:

1. Clinical practices do clinical practices meet the standards set and contribute to

the provision of high quality services?

2. Client satisfaction how do clients feel about the services offered; are theirneeds being met?

3. Provider satisfaction are the providers satisfied with how services are beingprovided?

4. Client flow and load is the clinic functioning as effectively and efficiently aspossible?

5. Client-provider interaction is communication between the providers and theclients respectful and mutually satisfying?


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6. Stock management are the essential supplies available and accessible whenneeded?

7. Record-keeping are the records being completed in a thorough and consistentmanner?

Question two: How to assess?

Situation VI

You are meeting with the team to decide how

best to determine if your site meets the

standards for clinical services. Some of the

providers do not appear to be comfortable

with you assessing their clinical skills. What

other options could you and the team use to

assess the clinical skills of the providers?

Write your responses.


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Methods for Assessing Site PerformanceASSESSMENT

METHOD

FOCUS OF

ASSESSMENT

PERSON

CONDUCTIN

G

ASSESSMENT

ASSESSMENT

METHODS / TOOLS

HOW TO USE THE

ASSESSMENT

RESULTS

Conduct Self

Assessment

Any worker at

the clinical siteTeams of

workers

Worker

Team

Checklist derived

from job descriptionand appropriate

guidelines

Person/team using

self assessment toolcan meet periodically

with the supervisor to

discuss areas of

achievement and

areas needing

improvement.

Conduct Peer

Assessment

Any worker at

the clinical site

Teams of

workers

Colleagues Checklist derived

from job description

and appropriate

guidelines

Peers can give

feedback to each

other in an informal

and comfortable

environment on

specific performance

areas.

Conduct

Supervisor

Assessment

Any worker at

the clinical site

Teams of

workers

Supervisor Meeting with staff

Observation of

clinical practice

Case reviews

Audits

Supervisor can share

the results with

individuals or teams

to acknowledge good

performance and

identify specific areas

needing

improvement.

Obtain Client

Feedback

People seeking

services at thesite

Staff

Supervisor

Meetings

Questionnaires/Interviews

Suggestion Box

Staff and supervisor

can evaluate siteoperations and staff

performance based

on feedback from

clients.

Poll

Community

Perceptions

People living in

the community

where the site is

located

Staff

Supervisor

Meetings

Questionnaires/

Interviews


can make changes to

site operations,

maybe even add new

services, based on

feedback from

community members.

ReviewRecords and

Reports

Any system oraspect of clinic

operations

StaffSupervisor

Review of records,reports, log books,

statistics

Staff and supervisorcan monitor

efficiency and

outcomes of clinic

operations.

Benchmark Any system or

aspect of clinic

operations

Staff

Supervisor

Visit other sites

Interview workers at

other sites

Interview clients and

community members

at other sites


can get new ideas

about how to provide

better services

Source: Supervising Health Services: Improving the performance of people (2001). Draft for

External Review. JHPIEGO- USAID. Maryland: USA.


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Part Four

Ethics & Supervision

4.1 Objectives of this part:

Define ethics. Know the ethical principles Discuss related issues important for the supervisor (human rights, informed

consent, privacy & confidentiality etc).

Identify the ethical guidelines that help supervisor to provide the best care.4.2 Ethics Defined: "is the process of making moral decisions about theindividuals & their interaction in society while still attempting to protect the right &

welfare of those same individual". (kurpius 1991). From this definition it is important

to know that supervisors who practice ethically should have correct combination of

education, practice & experience to help supervisees develop their skills.

4.3 Ethical principles

A) Principle of respect for persons:

Treating persons with rights. Respecting the autonomy of individuals. Protecting those who suffer loss of autonomy through illness, injury or

mental disorders. And working to restore it for those who lost it.

Recognizing that pts has such basic human rights as the right to know,privacy and to receive care & treatment.

B) Principle of justice:

Demand for universal fairness. Distributive justice not retributive. Justified public health measures:

o Not to lose sight of the individuals rights.o Non discriminationo Equality of outcomes for groups & relates to the broaderpolitical

responsibilities of health,professionals in controlling, allocatingresources.In planning research and development

C) Principle of beneficence:

Beneficence: is the duty to care

Advocacy: defending the right of the vulnerable client is a requirement of

beneficence.

It is indispensable whenever there are people in need of support or urgent care &

attention.

The reciprocity in our duty to care for one another should make us realized that

we all need others to speak with, do things for us or defend our right when we are

too weak to do so for ourselves.


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The power of true care is aimed at sharing knowledge & skills with the vulnerable

individual so as to empower that person to reassert control over her or his own life.

D) AccountabilityThis is one of the legal issues to be answerable for what one has done or not done,

according to the norms or standard of the particular role.In other word it is the responsibility of one's action.

Why we are in need for accountability.1. Increase technology.

2. Increase recognition.

3. Nursing role impact.

4. Moral and legal dimensions.

E) Competence

Supervisor needs to know everything, and more, than is expected of the supervisee.

The supervisor must be expert in the process of supervision. To achieve competence

supervisor receive training in performance of supervision as well as supervision ofsupervision.

F) Dual relationshipSupervisor should understand that dual relationship is to be managing properly.

G) Safety

All reasonable steps must be taken to ensure the safety of supervisees & their clients

during their work together.

H) Confidentiality

Confidentiality is an often-discussed concept in supervision because of some

important limits of confidentiality both within the therapeutic situation and within

supervision.

I) Liability

There are three safeguards for the supervisor regarding liability:

(1)Continuing education, especially in terms of current professionalopinion regarding ethical and legal dilemmas;

(2)Consultation with trusted and credentialed colleagues when questionsarise; and(3)Documentation of both counseling and supervision, remembering that

courts often follow the principle "What has not been written has not

been done" (Harrar, Vandecreek, & Knapp, 1990).


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CHAPTER TWO

COOMUNICATION: INTERACTING WITH OTHERS

IntroductionInteractive processes in organizations are crosscutting and multidimensional. They are

instruments for strategic and operational levels of management including those lying

at the first linea cornerstone of which is supervision and its interpersonal,

informational, and decisional roles. Many of the problems that occur in

organizations are the direct result of people failing to interact with one another. Faulty

interaction leads to confusion and can cause the best plan to fail. This chapter intends

to explore and look into such interactive processes and means for making them work

and promote supervision outcomes.

Aim of the chapterAfter completing the chapter participants will be able to demonstrate a good

understanding of the key interactive processes and skills including those of;

communication, conflict resolution, negotiation, problem solving and teambuilding.

Chapter objectives Grasp concepts related to communication, conflict, negotiation, delegation,

teambuilding, coaching and mentoring and problem solving. Comprehend the interrelatedness between the concepts above as processes

entailing different degrees of interaction between individuals and groups within

the organization.

Develop deep understanding of role the addressed concepts have in successfulimplementation of supervision in health care.

Employ gained knowledge in adopting tools needed for assessing andmeasuring various dimensions of supervision.


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2.1 What is communication?

Communication is the transference and understanding of meaning; a process from

send to receiver; skill includes speaking, listening and reasoning

Poor communications is one of most frequently noted sources of interpersonalconflict; yet we spend 70% of our time communicating

A Canadian study showed 61% of senior executives believed theycommunicated well with employees; whereas, 33% of those below in mid

management believed senior executives were effective and 22%-27% of non

management believed senior executives to be effective communicators

2.2 The process of communication;

Encoding: converting a communication message to symbolic form(by sender);

factors affecting how message encoded: skill, attitudes, knowledge, and socio-cultural

system

Decoding: retranslating a sender's communication message; affected by how

decoded: skill, attitudes, knowledge and socio-cultural system

Message: what is being communicated; speech, writing or visual; expression

Channel: the medium through which a communication message travels; formal

memos, emails, voicemail, meetings; channel choice depends on whether info is

routine (straightforward message less chance for misunderstanding) or non-routine

(more complicated and open to misinterpretation; high performing manager pays

attention to media used to communicate

Communication Apprehension: undue tension and anxiety about oral and/or written

communication; 5-20% suffer from this

Channel Richness: the amount of information that can be transmitted during acommunication episode; face to face scores highest on richness (ability to handle


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multiple cues, facilitate rapid feedback, and be personal; impersonal media such as

bulletins and general reports scores lowest on richness.

Feedback Loop: the final link in the process; puts the message backinto the system

as a check against misunderstandings; receiver needs to give feedback and sender

needs to check comprehension

2.3 Barriers to Communication

Anything that prevents understanding of the message is a barrier to communication.

Many physical and psychological barriers exist:

1. Culture, background, and bias - We allow our past experiences to changethe meaning of the message. Our culture, background, and bias can be good as

they allow us use our past experiences to understand something new, it is

when they change the meaning of the message then they interfere with the

communication process.

2. Noise - Equipment or environmental noise impede clear communication. Thesender and the receiver must both be able to concentrate on the messages

being sent to each other.

3. Ourselves - Focusing on ourselves, rather than the other person can lead toconfusion and conflict. The "Me Generation" is out when it comes to effective

communication. Some of the factors that cause this are defensiveness (we feel

someone is attacking us), superiority (we feel we know more that the other),

and ego (we feel we are the center of the activity).

4. Perception - If we feel the person is talking too fast, not fluently, does notarticulate clearly, etc., we may dismiss the person. Also our preconceivedattitudes affect our ability to listen. We listen uncritically to persons of high

status and dismiss those of low status.

5. Message - Distractions happen when we focus on the facts rather than theidea. Our educational institutions reinforce this with tests and questions.

Semantic distractions occur when a word is used differently than you prefer.

For example, the word chairman instead of chairperson, may cause you to

focus on the word and not the message.

6. Environment - Bright lights, an attractive person, unusual sights, or any otherstimulus provides a potential distraction.

7. Smothering - We take it for granted that the impulse to send usefulinformation is automatic. Not true! Too often we believe that certaininformation has no value to others or they are already aware of the facts.

8. Stress - People do not see things the same way when under stress. What wesee and believe at a given moment is influenced by our psychological frames

of references - our beliefs, values, knowledge, experiences, and goals.

9. Filtering: a sender's manipulation of informationso that it will be seen morefavorably by the receiver.

2.4 Triple-A-Listening to enhance communication

Listening is not the same as hearing. It is hearing with a purpose. Listening is a

conscious activity based on three basic skills: attitude, attention, and adjustment.
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These skills are known collectively as triple-A listening.

Maintain a constructive Attitude. A positive attitude paves the way foropen-mindedness. Don't assume from the outset that a supervisory session is

going to be dull. And even if the supervisee makes statements you don't

agree with, don't decide he or she is automatically wrong. Don't let reactiveinterference prevent you from recalling her/his key concerns.

Strive to pay Attention. You cannot attain concentration by concentratingon the act of concentration. Your attention must focus on the

substance/essence of the conversation. When you hear a conversation the

words enter your short-term memory, where they have to be swiftly

processed into ideas. If they aren't processed, then they will be dumped from

short-term memory and will be gone forever. Attentive listening makes sure

the ideas are processed.

Cultivate a capacity for Adjustment. Although some supervisors clearlyindicate what they intend to discuss, you need to be flexible enough to

follow the discussion regardless of the direction it may take. If, however,

you are thoroughly lost, or if the speaker's message is not coming across and

you need to ask a clarifying question, do so.

2.5 Good Listeners!

Look for the ideas being presented, not for things to criticize. Listen with the mind, not the emotions. Good listeners write down

something they disagree with to ask the speaker later, and then go on

listening.

Filter out distractions and concentrate on what the speaker is saying. Understand that speakers talk about what they think is most important. Good

listeners know that a good discussion may not contain the same information

as textbooks.

Want to see how the facts and examples support the speaker's ideas andarguments. Good listeners know that facts are important, because they

support ideas.

Want to learn something new and try to understand the speaker's point. Agood listener is not afraid of difficult, technical, or complicated ideas.

Listen closely for information that can be important and useful, even when adiscussion is dull.

Try to understand the speaker's point of view. Use any extra time or pauses to reflect on the speaker's message and think

about the next points.

2.6 Tips for Effective Listening

1. Make eye contact2. Use head nods and appropriate facial expressions3. Avoid distracting actions or gestures4. Ask questions5. Paraphrase (restate)6. Avoid interrupting the speaker


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7. Don't overtalk8. Make smooth transitions between role of speaker and listener

2.7 Communication and Conflict

Conflict can be a serious problem in organizations impacting on performanceand loss of good employees

But not all conflicts are bad; conflict has good and bad sides Conflict is a process that begins when one party perceives that another party

has negatively affected, or is about to negatively affect, something that the

first party cares about; conflict involves opposition, incompatibility or

interaction

2.8 Sources of Conflict are;communication problems like semanticdifficulty, misunderstanding, noise; structure and personal variables

Structure as a Conflict: when conflict is a function of the jobs people dorather than the personality; structure includes size (the larger the group the

more specialized and potential conflict especially where members are younger

and turnover high); jurisdictional ambiguity ( where definition of who does

what not clear a fight for territory/resources); diversity of goals among group (

example sales versus credit); too much reliance on participation (participation

and conflict highly correlated);reward systems (conflict when one member

gains at expense of others)

Personal Values as Conflict. personal variables include personalitycharacteristics, individual value system; example authoritarian type with low

self esteem lead to potential conflict; value systems explain prejudice,disagreements over one's contribution to group and rewards deserved

2.8 Conflict handling Intentions

Competing - assertive and uncooperative; intending to reach goal at sacrificeof other's goal; convincing another to take blame; best used when quick, vital

action needed, when unpopular action needed; against people who take

advantage of noncompetitive behaviour

Collaborating - assertive and cooperative; attempt to find a win-win; bestused when both sides concerns important, when object is to learn, merging

insights, working through feelings that have interfered

Avoiding - unassertive and uncooperative; ignoring; best used when issueunimportant, when little chance to satisfy concerns, when potential disruption

outweighs benefits of resolution, to cool down, when others can resolve

Accommodating - unassertive and cooperative; willing to sacrifice your goalsupport for another despite reservations; best used when you may be wrong or

a better position exists, to appear reasonable, team building, to minimize loss

Compromising mid range for both assertiveness and cooperativeness;acknowledging partial agreement or taking partial blame; best used when

goals not worth effort of disruption, for a temporary solution


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2.9 Conflict Resolution Techniques

1. Problem-solving (face to face to identify problem and discuss to resolve);

2. Superordinate Goals (creating a shared goal that needs cooperation of sides);

3. Expansion of Resources (when conflict is from lack of money, resources,space expansion can be win-win);

4. Avoidance (withdrawal);

5. Smoothing (play down difference and emphasize similarity);

6. Compromise (each gives up something);

7. Authoritative Command (formal resolution by upper level);

8. Altering human variables (using human relations to alter behaviour);

9. Altering the structural variable (changing format by job redesign,

transfer, coordination position


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2.10 Communication through 'Delegation'

It is impractical for the supervisor to handle all of the work of the department directly.

In order to meet the organization's goals, focus on objectives, and ensure that all work

is accomplished, supervisors must delegate authority. Authority is the legitimate

power of a supervisor to direct subordinates to take action within the scope of thesupervisor's position. By extension, this power, or a part thereof, is delegated and used

in the name of a supervisor.

Delegation is the downward transfer of formal authority from superior to subordinate.

The employee is empowered to act for the supervisor, while the supervisor remains

accountable for the outcome. Delegation of authority is a person-to-person

relationship requiring trust, commitment, and contracting between the supervisor and

the employee.

The supervisor assists in developing employees in order to strengthen the

organization. He or she gives up the authority to make decisions that are best made by

subordinates. This means that the supervisor allows subordinates the freedom to make

mistakes and learn from them. He or she does not supervise subordinates' decision-

making, but allows them the opportunity to develop their own skills. The supervisor

lets subordinates know that he or she is willing to help, but not willing to do their jobs

for them. The supervisor is not convinced that the best way for employees to learn is

by telling them how to solve a problem. This results in those subordinates becoming

dependent on the supervisor. The supervisor allows employees the opportunity to

achieve and be credited for it.

An organization's most valuable resource is its people. By empowering employeeswho perform delegated jobs with the authority to manage those jobs, supervisors free

themselves to manage more effectively. Successfully training future supervisors

means delegating authority. This gives employees the concrete skills, experience, and

the resulting confidence to develop themselves for higher positions. Delegation

provides better managers and a higher degree of efficiency. Thus, collective effort,

resulting in the organization's growth, is dependent on delegation of authority.

2.11 Responsibility and Accountability

Equally important to authority is the idea that when an employee is given

responsibility for a job, he or she must also be given the degree of authority necessaryto carry it out. Thus, for effective delegation, the authority granted to an employee

must equal the assigned responsibility. Upon accepting the delegated task, the

employee has incurred an obligation to perform the assigned work and to properly

utilize the granted authority.

Responsibility is the obligation to do assigned tasks. The individualemployee is responsible for being proficient at his or her job. The

supervisor is responsible for what employees do or fail to do, as well as for

the resources under their control. Thus, responsibility is an integral part of

a supervisor's authority.
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Responsibilities fall into two categories: individual and organizational

1. Individual responsibilities to be proficient in their job. Employees areresponsible for their actions. Nobody gives or delegates individual

responsibilities. Employees assume them when they accept a position in the

organization.2. Organizational responsibilities refer to collective organizational accountability

and include how well departments perform their work. For example, the

supervisor is responsible for all the tasks assigned to his or her department, as

directed by the manager.

When someone is responsible for something, he or she is liable, or accountable

to a superior, for the outcome. Thus, accountability flows upward in the

organization. All are held accountable for their personal, individual conduct.

Accountability is answering for the result of one's actions or omissions. Itis the reckoning, wherein one answers for his or her actions and acceptsthe consequences, good or bad. Accountability establishes reasons,

motives and importance for actions in the eyes of managers and employees

alike. Accountability is the final act in the establishment of one's

credibility. It is important to remember that accountability results in

rewards for good performance, as well as discipline for poor performance.

2.12 Important tips in delegation1. The first step in delegating is to identify what should and should not be

delegated.2. The supervisor should delegate any task that a subordinate performs better.3. Tasks least critical to the performance of the supervisor's job can be delegated.4. Any task that provides valuable experience for subordinates should be

delegated.

5. The supervisor can delegate the tasks that he or she dislikes the most.6. The supervisor should not delegate any task that would violate a confidence.

2.13 The Delegation Process. The delegation process has five phases;

1. Preparing includes establishing the objectives of the delegation, specifying thetask that needs to be accomplished, and deciding who should accomplish it.

2. Planning is meeting with the chosen subordinate to describe the task and to askthe subordinate to devise a plan of action. As Andrew Carnegie once said, "The

secret of success is not in doing your own work but in recognizing the right man

to do it." Trust between the supervisor and employee - that both will fulfill the

commitment - is most important.

3. Discussing includes reviewing the objectives of the task as well as thesubordinate's plan of action, any potential obstacles, and ways to avoid or deal

with these obstacles. The supervisor should clarify and solicit feedback as to the

employee's understanding. Clarifications needed for delegation include the

desired results (what not how), guidelines, resources available, and


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consequences (good and bad). Delegation is similar to contracting between the

supervisor and employee regarding how and when the work will be completed.

The standards and time frames are discussed and agreed upon. The employee

should know exactly what is expected and how the task will be evaluated.

4. Auditing is monitoring the progress of the delegation and making adjustmentsin response to unforeseen problems.

5. Appreciating is accepting the completed task and acknowledging thesubordinate's efforts.


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2.14 Communicating through 'Coaching and Mentoring'

Both coaching and mentoring are enabling processes meant to achieve people's full

potential.

Coaching is "a process that enables learning and development to occur and thusperformance to improve. To be a successful a Coach requires a knowledge and

understanding of process as well as the variety of styles, skills and techniques that are

appropriate to the context in which the coaching takes place" (Parsloe, 1999).

Mentoring is"off-line help by one person to another in making significant transitions

in knowledge, work or thinking". It is the process of gaining wisdom from, and

tapping into the experience of, others. We all have mentors, whether we call them that

or not - heroes, people we seek to imitate, people we've learned from.

2.15 Common things coaches and mentors do 'similarities'.

Facilitate the exploration of needs, motivations, desires, skills and thoughtprocesses to assist the individual in making real, lasting change.

Use questioning techniques to facilitate client's own thought processes in orderto identify solutions and actions rather than takes a wholly directive approach

Support the client in setting appropriate goals and methods of assessingprogress in relation to these goals

Observe, listen and ask questions to understand the supervisee 's situation Creatively apply tools and techniques which may include one-to-one training,

facilitating, counselling & networking.

Encourage a commitment to action and the development of lasting personalgrowth & change.

Maintain unconditional positive regard for the supervisee, which means that thecoach is at all times supportive and non-judgemental of the client, their views,

lifestyle and aspirations.

Ensure that supervisee develop personal competencies and do not developunhealthy dependencies on the coaching or mentoring relationship.

Evaluate the outcomes of the process, using objective measures whereverpossible to ensure the relationship is successful and the supervisee is achieving

their personal goals.

Encourage supervisee to continually improve competencies and to develop newdevelopmental alliances where necessary to achieve goals.

Work within his/her area of personal competence. Possess qualifications and experience in the areas that skills-transfer coaching

is offered.


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2.16 How do coaching and mentoring compare with Traditional

forms of training?

Traditional forms of training Coaching/mentoring

Wholesale transfer of new skills,e.g. change in procedures, new

systems (e.g. software application

training), new job function.

Programmes are mostly genericand not tailored to individual

needs. Delegates generally have to

complete standard modules, so

there is little room for tailoring the

programme to account for existing

knowledge, skills or preferences. Not always sufficiently similar to

the live working environment to

ensure effective skills transfer.

Best suited to transfer ofknowledge and certain skills rather

than the development of personal

qualities or competencies

Actively untaps potential. Fine tunes and develops skills. Development activities are designed to suit

clients personal needs and learning styles.

Eliminates specific performance problems. Can focus on interpersonal skills, which

cannot be readily or effectively transferred

in a traditional training environment.

Provides client with contacts and networksto assist with furthering their career or life

aspirations. Performed in the live environment Highly effective when used as a means of

supporting training initiatives to ensure

that key skills are transferred to the live

environment.

Coaches and mentors transfer the skills tothe client rather than doing the job for

them.

2.17 Coaching Skills & Tips

Coaching is about building a person's confidence and capability, about encouraging

them to discover things for themselves, and enabling them to achieve more,

developing their gifts and talents in the process.

2.17.1 Building confidence means that you:

Actively listen. Provide help, support and the necessary resources. Involve the person in deciding on and setting goals and targets. Show enthusiasm and belief in the person. Acknowledge the person's successes. Reflect back to the skills and talents they have already demonstrated. Are honest about their worries and concerns, openly discussing their fears and

looking at the worst possible outcomes.

2.17.2 You can encourage people to find things out for themselves by:

Asking open questions to stimulate them into thinking about what they want to do. Asking how the person would like to take things forward.
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Encouraging them to come up with their own ideas. Listening to their ideas. Encouraging them to see the consequences of their proposed actions. Asking if they have other alternative suggestions. Offering your own ideas as suggestions. Asking the person what success looks like. Giving the person time to think.2.17.3 Eight coaching tips to the coach from those on the receiving end

1. Treat me as a person in my own right.2. Set me a good example.3. Encourage and support me.4. Praise me when I do well.5. Back me up in front of others6.

Keep me informed about what I need to know7. Take time from your normal duties to coach me.

8. Never under-estimate what I can do.2.17.4 Unwilling learners

Not everyone takes kindly to being coached. It may take considerable tact and

perseverance to help someone to accept help. Whether someone is willing to be

coached may depend on the approach you adopt with them.

If you push hard, confront, challenge and criticise, you may simplygenerate resistance or withdrawal.

By staying cool and dispassionate as a coach, you may help learners tothink things through for themselves.

Yet if you are too distant you may be regarded as impersonal and uncaring. Similarly, an over-enthusiastic coach can motivate through excitement

and energy, yet may be seen by some people as intimidating and

overwhelming.

Be willing to experiment with your coaching style.


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2.18 Communication for 'Team Building'

Team building is an effort in which a team studies its own process of working

together and acts to create a climate that encourages and values the contributions of

team members. Their energies are directed toward problem solving, task

effectiveness, and maximizing the use of all members' resources to achieve the team'spurpose. Sound team building recognizes that it is not possible to fully separate one's

performance from those of others.

2.19 Phases of Development of effective teams

A team begins as nothing more than a collection of individuals who have been

brought together in a work situation. The process of uniting the group to form an

effective team involves successfully completing fourphases of development

identified by B.W. Tuckman (1965): forming, storming, norming, and performing.

Phase one is an orientation, the forming of the team. Each person, in the process of

getting acquainted with the other members, seeks his or her place in the group. The

members must reach a common understanding of their objective, as well as agreement

on basic operational ground rules, such as when to meet, attendance requirements,

how decisions will be made, and so on.

Do members understand the team's objectives?

Have member's individual objectives been incorporated into the team's

objectives?

Do members feel the team's objectives are achievable and reflect their own

personal objectives?

Phase two is characterized by interpersonal conflict, the storming of the team.

Individuals begin to compete for attention and influence. Divergent interests surface

as members begin asserting their ideas and viewpoints of the task, and their feelings

about other members. The group must settle issues of how power and authority will

be divided among members.

What do members see as their responsibilities?

What do members expect from other members?

How is leadership being handled?

Does duplication of effort exist?

Phase three, the group is becoming cohesive, the norming of the team. A sense of

identity or "team spirit" is beginning to develop. Individuals become more sensitive to

each other's needs, and are more willing to share ideas, information, and opinions.

Task considerations start to override personal goals and concerns.

What is the action plan for achieving the objectives?

How are decisions made?

How are problems solved?

How are conflicts resolved?
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Phase four is the interdependence of the group, the performing team. The group

emerges as a team. Members now work well together and have a high degree of

productive problem solving, since structural and interpersonal issues have been

resolved. High creativity and intense loyalty of members to each other characterize a

group at this stage.

How do the members treat each other?

Do members trust, support, and feel comfortable with each other?

Do members look for ways to help each other?

2.20 Characteristics of Good Team Building

High level of interdependence among team members Team leader has good people skills and is committed to team approach Each team member is willing to contribute Team develops a relaxed climate for communication Team members develop a mutual trust Team and individuals are prepared to take risks Team is clear about goals and establishes targets Team member roles are defined Team members know how to examine team and individual errors without

personal attacks

Team has capacity to create new ideas Each team member knows he/she can influence the team agenda

2.21 Evaluating Team Effectiveness

When evaluating how well team members are working together, the following

statements can be used as a guide:

Team goals are developed through a group process of team interaction andagreement in which each team member is willing to work toward achieving

these goals. Participation is actively shown by all team members and roles are shared

to facilitate the accomplishment of tasks and feelings of group togetherness.

Feedbackis asked for by members and freely given as a way ofevaluating the team's performance and clarifying both feelings and interests of

the team members. When feedback is given it is done with a desire to help the

other person.

Team decision making involves a process that encourages active participationby all members.

Leadership is distributed and shared among team members andindividuals willingly contribute their resources as needed.

Problem solving, discussing team issues, and critiquing teameffectiveness are encouraged by all team members.


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Conflict is not suppressed. Team members are allowed to express negativefeelings and confrontation within the team which is managed and dealt with by

team members. Dealing with and managing conflict is seen as a way to improve

team performance.

Team member resources, talents, skills, knowledge, and experiences arefully identified, recognized, and used whenever appropriate.

Risk taking and creativity are encouraged. When mistakes are made, they aretreated as a source of learning rather than reasons for punishment.

After evaluating team performance against the above guidelines, determine those

areas in which the team members need to improve and develop a strategy for doing

so.


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2.13 Communication for 'Problem Solving' Day-to-day situations involving supervisory decisions include;

a) Employee moraleb) The allocation of effort,c) The materials used on the jobd) The coordination of schedules and work areas.

The supervisor must;a. Recognize problems,

b. Make a decision,c. Initiate an action,d. Evaluate the results.

In order to make decisions that are consistent with the overall goals of theorganization, supervisors use guidelines set by top management. Thus, it is

difficult for supervisors to make good decisions without good planning.

An objective becomes a criterion by which decisions are made. A decision is a solution chosen from among alternatives. Decisions must be

made when the supervisor is faced with a problem.

Decision-making is the process of selecting an alternative course of actionthat will solve a problem. The first decision is whether or not to takecorrective action. A simple solution might be to change the objective. Yet, the

job of the supervisor is to achieve objectives. Thus, supervisors will attempt to

solve most problems.

A problem exists whenever there is a difference between what actuallyhappens and what the supervisor wants to have happen. Some of the problems

faced by the supervisor may occur frequently. The solutions to these problems

may be systematized by establishing policies that will provide a ready solution

to them. In these repetitive situations, the problem solving process is used

once and then the solution (decision) can be used again in similar situations.

Exceptions to established routines or policies become the more difficultdecisions that supervisors must make. When no previous policy exists, the

supervisor must invent a solution.

Problem solving is the process of taking corrective action in order to meetobjectives. Some of the more effective decisions involve creativity. To get

better ideas, the supervisor follows the steps in the problem solving process.

The steps are built on a logical analysis.


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The supervisor can think through all aspects of the problem by answering thefollowing questions.

oWhat seems to be the trouble?oWhy is it causing the trouble?oWhat are the causal factors?oWhat can be done in all possibilities?oAre all these possibilities workable?oWhat are the probabilities of success for each of the solutions?oWhat are the appropriate alternatives?oWhat is the correct choice?oHave I logically eliminated the other choices?oWhen and how can the solution be implemented?oWhat is the best way to implement the solution?oHas the solution solved the original problem?oHave I planned, organized, and provided for the control of actions

leading to solutions?

2.14 Steps in problem Solving.

(1) define the problem, (2) identify decision criteria,

(3) develop alternatives, (4) decide,

(5) implement the decision, and (6) evaluate the decision.

Step 1: Define the problem. The problem solving/decision-making process beginswhen the supervisor recognizes the problem, experiences pressure to act on it, and has

the resources to do something about it. This means that the supervisor must correctly

define the problem. Problem identification is not easy. The problem statement can be

too broad or too narrow. Supervisors are easily swayed by a solution orientation that

allows them to gloss over this first and most important step. Or, what is perceived, as

the cause of a problem may actually be a symptom.

The supervisor must solve the right problem. In order to define the problem, the

supervisor must describe the factors that are causing the problem. These are the

symptoms, visible as circumstances or conditions that indicate the existence of the

problem -- the difference between what is desired and what exists. By not clearlydefining the problem, ineffective action will be taken.

Step 2: Identify decision criteria. The supervisor determines what is relevant in

making a decision by isolating the facts pertinent to the problem. Since there is no

single best criterion for decision making where a perfect knowledge of all the facts is

present, a set of criteria must be used for the problem at hand. These decision criteria

identify what will guide the decision-making process. They are the important facts

relevant to the problem as defined. It is important that decision criteria be established

early in the problem solving process because if the criteria are developed as analysis

of data is taking place, the chances are good that the data will determine the criteria.

Thus, setting the criteria early introduces objectivity. These facts can be tangible aswell as intangible. Tangible facts might include the work assignments, the work
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schedules, or work orders. Intangible facts could include morale, motivation, and

personal feelings and perceptions.

This process is somewhat subjective, because what serves as important criteria for one

supervisor may be less important for another. For instance, the decision-making

criteria used to hire employees differs across departments; the sales department usesthe number of new store openings in different geographic areas, while the

manufacturing department uses how many units of the product needs to be produced

and how quickly.

Key uncertainties, the variables that result from simple chance, must be identified.

Regardless of the solution chosen, key uncertainties are important because they can be

plusses or minuses. What are the chance variables? Which way would these variables

fall, relative to each of the workable solutions?

Not all criteria have the same importance. (Criteria weights can vary among different

supervisors as well.) Assigning weights indicates the importance a supervisor placeson each criterion for resolving the problem and helps establish priorities. Criteria that

are extremely important can be given more weight, while those that are least

important can be given less weight.

Step 3: Develop alternatives. The supervisor must identify all workable alternative

solutions for resolving the problem. The term workable prevents alternative solutions

that are too expensive, too time-consuming, or too elaborate. The best approach in

determining workable solutions is to state all possible alterna

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