Elements of effective dissemination

Conducting supervisory visits and feedbackStrengthening Monitoring and Evaluation for Malaria ProgramsTraining Curriculum for GMS Country M&E TeamsChiang Mai, Thailand, 26 September 2012Unit 3: Malaria Monitoring & Evaluation Sub-Unit 3.3: Reporting, Action, Feedback

1Learning objectives:By the end of this section, you should be able to Have better understanding of the principles of supportive supervisionDemonstrate skills in preparing and conducting supervisory visitProvide appropriate feedback to implementers2What is supervision?Support system aimed at improving knowledge, attitudes and skills of health staff, and the quality of health programmes Purpose of Supervision: Improve programme efficiency and effectiveness)

http://www.elisamortiz.org/2011/01/7-skills-for-supervision-success/ accessed 22/09/2012

3Other terms for SupervisorTrainerAdvisorMentorFacilitatorCoach

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5Supportive vs. Punitive SupervisionCharacteristicsSupportivePunitiveObjectivesidentify problems and help health workers solve them.To recognize good performance.To show health workers that their performance matters.To identify flaws and reprimand thoseresponsibleTechnical basisBehavioural science, communication skillsand programme planning are all important technical skills.No technical basis used in interpersonalcontact6Supportive vs. Punitive SupervisionCharacteristicsSupportivePunitiveTools and methodsDiverse strategies to assess and understand the situationObservation of practices and environmentListening to concerns and offering helpSharing informationGood communication skillsInflexible use of checklistsJudging based on assumptions, impressionsor hearsayIntimidationWithholding informationPoor communication skillsFeedbackRecognizes achievements.Focuses on problems that are solvable. Offers trainingand support.Very little positive feedback. Feedback is usually unstructured and critical.7Exercise 1: Improve the organization of supervisory visitsPurpose: Answer questions about supervision and plan how to improve organization of supervision in your programmeUsing your own experience, select one intervention, identify problems and plan for supervisory visits? What could you do to manage these problems?Intervention:

ProblemsHow manage (solutions)8Exercise 1: Improve the organization of supervisory visitsBased on identified problems, outline an improved organization of supervisory visit for the intervention you have considered

WhereWhat and who to superviseSupervisory methodsWhen:FrequencyWho will conduct sup. visitsOther interventions that could be supervised at the same timeCommunityHealth FacilityDistrict levelProvincial levelCentral Level9What to supervise: Questions to considerWhat are the key tasks of clinical practice or case management performed by health staff that should be checked against the technical standards?In what activities is there a failure to perform adequately? What specific failures would seriously interfere with the success of the programme?What tasks and activities are the most difficult or challenging for health workers?What tasks and activities are new to health workers?What do the clients complain about?10Methods used during supervisory visitsObservation Dialogue/discussionReview of recordsExit interviewsCommunity interviews

Good supervision involves interaction, is supportive, not punitive!11Frequency of supervisory visitsFrequently enough to provide needed support Monthly to health facilities and community levelQuarterly to districtsEvery six months to Provincial level

12Who should conduct supervisory visitConsider :geographic proximityActivities or tasks to be assessed (clinical vs. administrative)Previous training/experience of the supervisor (including use of supportive techniques)Who will be supervised (nurse, clinician, data entry clerk, lab technician?)Availability

13Exercise 2 Role Play: Conduct supervisory visit, give feedback and solve problemsFor this part of the exercise, you will practise conducting a supervisory visit, giving feedback . One person will play the role of the supervisor and one will play the role of a health worker at a first-level health facility.

14Scenario 1Health Centre setting (2 health workers attending to a patient in the OPD)Supervisor comes in unannounced (walks in hands inside pocket)Asks for all staff member to assemble (stands akimbo)Takes roll call (identifies absentees)Ask staff members if they know his position Introduces himself

15Scenario 1Told them of his missionAsk for some documentsScribble down some few notes He told the staff members present, all absentees will read from the Headquarters very soonHe departs, fuming ... (without any guidance)

16Scenario 2Health Centre setting (2 health workers attending to patient in the OPD)Supervisor and team comes in (apologises for slight delay in arrival)Exercises patience while health work concludes consultationIntroduces himself and his colleagueHe explains his mission (referring to a letter sent to HF earlier)He asks after the staff family, work, welfare, etcJointly they all reviewed some documents and discussed for a while

17Scenario 2He paid a courtesy call on the Head of the Town to than him for his supportHe asked staff members to call him if there are more issues to be discussed He promised to share his report before sharing with the higher authorityStaff saw him off to his vehicle (waving happily as he departs)

18Tasks during role pay by other members of groupsNote:Steps taken to prepare for the visitSteps during the visitverbal and non-verbal communicationwhether the problem was clearly describedwhether causes were analysed and the health workers ideas were consideredwhether the solutions to the problem were agreed, andwhether the health worker had a chance to raise other concerns or questions.19Tasks after role pay by other members of groupDiscuss whether the appropriate steps were taken during the role play and the manner of the feedback.Other participants will act in additional role plays, as time allows.207 skills for effective supervisionListeningAvailability (physically and mentally)Mission focus and priority/action orientedTransparency DelegationResponsibilities (clear expectations and regular feed back)Authority (decision making)Accountability (for results)Taking responsibilities and giving creditRealism (Do not promise heaven)

http://www.elisamortiz.org/2011/01/7-skills-for-supervision-success/ accessed 22/09/2012

21Steps to prepare for a supervisory visitReview past performance at the facility/health serviceFind out about follow-up actionsCollect appropriate checklists and recording formsPrepare to inform staff at the facility of any updates, plansCollect supplies, equipment, and/or materials that can be deliveredCollect materials to take so that you will be prepared for problem solvingConfirm logistic arrangements22Steps to conduct a supervisory visitPrivate interview with the person in-chargeA review and assessment of current practices, procedures, logistics (walk about)A technical assessment of the performance of the health workers and the health servicesA discussion of perceptions of services and activities with caregiversFeedback of resultsAn opportunity for health workers to ask questionsProblem solvingPlan for next steps.Action after the visit23How to conduct a problem-solving discussionIdentify the likely cause (causes) of the problemResponsibility of the task clearly assigned?Health worker lack necessary knowledge and skills?Health worker lack motivation?Are there obstacles (time, authority, funds, supplies, etc.)Define one or more feasible solutions

24Techniques for giving feedbackComments task orientedFeedback should be prompt MotivatingAction-orientedConstructive25Key supervisory tasksMotivateProvide feedbackResolve performance problemsBlend employee goals with work requirementsImprove communications and keep employees informedResponsible for employee training and skills

www.philadelphia.edu.jo accessed 22 September 201226Attributes of a good supervisorExcellent communication skillsFairness (in delegating tasks)Good organizational skillsKnowledge of the subjectAccountability Efficiency (right task to the right person)AdaptabilitySocial skills (culture sensitive, polite but assertive)Diplomacy (managing different expectations)Self-disciplinehttp://martinecallaghan.hubpages.com accessed 22 September 201227Take home messagesSupportive supervision, an essential component of programme management cycle (Plan Do Check Act)Supportive supervision is informed by the needs: importance of the what and who is supervised, how, when, and by whomGood preparation and systematic approach enhances the effects of the visitsGood feedback should be task oriented, prompt , motivating, action-oriented and constructive

28Thank you!

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