1.  Introduction
It is widely acknowledged that developing and maintaining a supportive and open culture within an organisation, that also meets the needs of all individuals working within it, promotes an enhanced working environment and best quality care. 
 
Our hospice is committed to building a supportive and responsive culture with a wide range of staff support initiatives to best support staff in their work and their professional development to ensure care of the highest quality.  
 
Clinical supervision and reflective practice has an important role in creating a culture in which professional practice can develop and has the potential to significantly enhance the well being of frontline clinical staff. 
 
Nevertheless, establishing a system of clinical supervision or reflective practice for all frontline clinical staff has posed real challenges in the past. Securing the necessary time, training and financial resources for all clinical staff to have clinical supervision on an individual basis, has never been feasible due financial constraints and the large numbers of staff involved.
 
 
2.  Background to the project
In 2006 we established a working group to explore different options and initiatives in providing clinical supervision or reflective practice for all clinical staff.
 
At that time we were providing
¨ One to one formal clinical supervision for grades F  (AfC band 6a) and above only
¨ Formal and informal group supervision – for clinical and non clinical groups
¨ Assigned mentorship & preceptorship support.
¨ Professional and mentorship guidance for new clinical staff
¨ Peer supervision & ward managers meetings
¨ Adhoc reflective practice sessions/clinical incident debriefings
¨ Monthly clinical forums
¨ Monthly clinical forum meeting
 
 
3.  Audit of Clinical Support and Stress
The working group conducted an audit to establish views on clinical support and stress.

Results overall demonstrated that clinical staff felt lacking in support despite access to available forums.  Most would welcome a regular opportunity to reflect on their practice.
 
4.  Our Action Plan
In 2007, in response to the audit we implemented an exciting new initiative of group reflective practice  sessions for all clinical staff. 
 
Our aim was to bridge the gap in our provision of clinical supervision for clinical staff in Agenda for Change Band 5 and below (trained and untrained) and provide enhanced support through group reflective practice. 
 
This was felt to be the most effective way of providing much-needed and appropriate clinical support to a large number of staff.  The overall aim of this project was to  enhance well being and encourage ongoing professional development.  
 
Consideration was given to the view that those who willingly volunteer themselves for clinical supervision or reflective practice are not always the staff that would gain the most benefit from it.  With this in mind it was decided that attendance should be mandatory for all clinical staff and built in as part of the appraisal process.
 
Much thought was given to the change management process, the need for excellent communication of audit results and the rationale behind our decision-making.
 
5.  Mandatory Group Reflective Practice
 
The system of group reflective practice sessions
¨ Mandatory for all clinical staff of AfC Band 5 and below
¨ Hour long sessions supervised/facilitated by a skilled and experienced member of the hospice clinical team.
¨ Eight groups of 5 – 8 individuals meet bi-monthly throughout the year
¨ Every individual is required to attend at least 3 out of the 6 sessions provided each year.
¨ Attendance is monitored as part of the appraisal process
¨ Bank staff are invited to attend but attendance is not mandatory
¨ A repeat audit to be conducted after two years to analysis and evaluate the effectiveness of the system.

What is Reflective Practice?

¨ Each nurse is required to be a reflective practitioner and reflect on their practice constantly
¨ We need to be responsive and reflective instead of simply carrying out tasks without question
¨ Saint Francis hospice is dedicated to allowing each nurse the time to reflect with their colleagues in a group setting.
¨ Reflection is a process that allows practitioners to uncover and expose thoughts, feelings and behaviours
¨ Having time set aside to reflect in a safe, facilitated group to allow participants to value their current practice and explore how to proceed in challenging situations.

 6.  Attendance Monitoring
Over the two year period, after a tentative start with significant levels of negativity and opposition the clinical teams warmed to the initiative.  Facilitators reported that their groups were welcoming the opportunity to bring clinical issues, development issues, and communication challenges to their groups for discussion and exploration in a safe and protected environment.   
 
Attendance has been monitored throughout.  Of the 59 members of the clinical team that attended, over three quarters (or 78%) attended three or more of the four sessions provided.  The chart below provides a full breakdown of attendance.

 7.  Repeat Audit Results
A repeat audit carried out at the end of the second year confirmed early indications that group reflective practice was proving to be a positive and valuable experience for the clinical team.

Conclusion

We are wholly committed to providing, comprehensive guidance and support to maintain the well-being and resilience of all staff.  Reflective practice has a pivotal role in creating a culture in which professional practice can be developed, and can significantly enhance the well being of front line clinical staff. 
 
We were delighted that the audit cycle and repeat audit results supported empirical evidence to demonstrate that our clinical teams have benefited hugely from the implementation of mandatory reflective practice; as has our multi-professional team working. 
 
Without doubt, our introduction of a system of group reflective practice has enabled us to better support staff in their work and their professional development and accordingly ensure delivery of the best quality services to patients and their families. 
 

If you would like a copy of our prospectus please call 01708 771408 or take a look at our courses