MBA in Health Services Management

PERFORMANCE EMBEDDED IN PROFESSIONAL SUPERVISION – THE WAY FORWARD FOR SOCIAL WORK

Helen Teresa Anne Hanlon

Submitted in partial fulfilment of the requirement for the degree of Masters of Business Administration in Health Services Management

Thesis Supervisor:

Ms. Anna Jennings, School of Applied Social Science, University College Dublin.

Graduate School of Business

University College Dublin

Royal College of Surgeons in Ireland

April 2007

Abstract

This study explores participant’s perceptions of the management function of supervision and how it can be linked to a robust performance management system for social workers.

The literature review gives an overview of the meaning and purpose of professional supervision. It also considers the complex context of child protection work that supervison takes place in. The key literature relating to the management function and performance management is examined.

The research strategy employed is qualitative and exploratory in nature and involves semi-structured interviews with team leaders and social workers. Analysis is carried out using a template analysis approach.

The key findings reaffirm that the management function is the predominant agenda in supervision with case discussion and action planning the central activities. The organisations statutory and legal requirements drive current supervision activities. Key supervision deficits include limited time for reflective practice, formal appraisals and structured and regular feedback on performance. All respondents identify that the current supervision policy is not regarded as a living, working document and in some instances is completely discounted. Furthermore, respondents identify the requirement for an integrated approach to supervision as set out in the supervision policy, which incorporates the Morrison model of supervision. High quotas of staff to be supervised as well as other competing demands on team leaders are key barriers to implementation.

There is a culture of recognition and acceptance to social work performance being embedded in professional supervision and team-based approaches to performance management. However for this to happen there is an organisational imperative to reduce the case and workloads of both team leaders and social workers. The research concludes with recommendations for the organisation to cultivate an integrated approach to the performance management of social workers.

Dedication

To my beloved mother who encouraged her children to value and cherish the importance of education and learning as a worthwhile vehicle to achieving the best that this life can give. Thank you for helping me to achieve the very best that is possible.

Declaration

I hereby declare that:

q This thesis has not been submitted as an exercise for a degree in any other University here in Ireland or in any other country.

q This is entirely my own work.

q The collective Libraries of University College Dublin, incorporating The Graduate Business School and The Royal College of Surgeons may lend or copy this thesis, on request.

Acknowledgements

My sincere thanks and appreciation to all my colleagues in social work who kindly participated in this study. Their time and interest in sharing their knowledge and professional views is greatly appreciated. Both social workers and team leaders work in a highly fluid, pressurised and complex environment on a day to day basis with children, young people and families and yet remain deeply committed and motivated in their work.

Thanks to Fergal McDonald for facilitating me in studying for the Masters in Business Administration in Health Services Management and for his support around this research project. Also to Denise Keoghan for her advice and assistance in generating research ideas.

A special thanks to Ms. Anna Jennings, School of Applied Social Science, University College Dublin, my supervisor who provided sound knowledge, guidance and much encouragement during the course of this thesis. Also to my fellow students who provided a listening ear when I needed one.

A special thanks to my family for their support and guidance and especially to my sister Phil for her continued and relentless optimism and enthusiasm.

A special thanks to my friends for their constant encouragement and patience when I was buried in paper.

A special thanks to Mena Dooley for her expert advice and guidance in the technical editing of this document.

ABSTRACT 3

DEDICATION 4

ACKNOWLEDGEMENTS 6

TABLE OF CONTENTS 7

LIST OF EXHIBITS AND TABLES 11

CHAPTER ONE

INTRODUCTION 13

1.1 INTRODUCTION

1.2 DEFINITION OF TERMS 14

1.2.1 Professional Supervision 14

1.2.2 Performance Management 14

1.2.3 Health Service Executive 14

1.2.4 Transformation Programme 15

2007-2010

1.2.5 OPM 15

1.2.5 Management Function of 16

Supervision

1.2.7 Mentoring, Coaching and Personal 16 Development Planning(PDP)

1.2.8 Social Care 16

1.2.9 Group Supervision 16

1.2.10 Team Based Supervision 17

1.2.11 Peer Supervision 17

1.3 RATIONALE FOR THE STUDY 17

1.4 OBJECTIVES 18

1.5 RESEARCH QUESTION DEFINED 18

1.5.1 Main Research Question 18

1.5.2 Subsidiary Questions 19

1.6 RESEARCH METHODOLOGIES 19

1.7 CHAPTER FORMAT 20

CHAPTER TWO

AGENCY AND POLICY CONTEXT

2.1 INTRODUCTION 22

2.2 KEY DRIVERS 23

2.3 PERFORMANCE MANAGEMENT 25

2.4 HSE TRANSFORMATION PROGRAMME 28

2.5 CONCLUSION 28

CHAPTER THREE

LITERATURE REVIEW

3.1 SECTION A – INTRODUCTION 30

3.2 WHAT IS PROFESSIONAL SUPERVISION? 30

3.3 THE HISTORICAL CONTEXT AND MODELS OF SUPERVISION 33

3.4 MORRISON MODEL OF SUPERVISION 35

3.5 MORRISON – SUPERVISION DEFINED AS A STRUCTURED PROCESS 36

3.6 MORRISON – SUPERVISORY PROCESSES 36

3.7 MORRISON – SERVICE USER/CLIENT

OUTCOMES 36

3.8 WHAT IS SIGNIFICANT ABOUT SUPERVISION

IN CHILD PROTECTION AND WELFARE

SERVICES? 37

3.8.1 Effective Delivery of Services 38

3.8.2 Organisational Containment of Stress,

Anxiety and Burnout 38

3.8.3 Managing Staff Retention and the

Psychological Impact of the Work 39

3.8.4 Quality Assessment Work with Children

and Families 40

3.8.5 Supervision in a Highly Fluid and

Turbulent Environment 40

3.9 CONCLUSION 41

3.10 SECTION B – THE MANAGEMENT FUNCTION

3.10.1 Integrated Approach to Supervision 42

3.10.2 The Management Function – Definition 43

3.10.3 The Management function –

Compliance with Agency Policies 43

3.10.4 Accountability – The Predominant

Agenda 44

3.10.5 High Rates of Attrition 45

3.10.6 Compromised Practice 45

3.10.7 Evidence of inadequate Supervision 46

3.10.8 Validating Supervisory Experiences 48

3.10.9 Prescriptive Supervisory Practices 48

3.10.10 Training for Supervisor Competence 49

3.11 CONCLUSION 50

3.12 SECTION C - MOVING TOWARDS

A PERFORMANCE MANAGEMENT AND MEASUREMENT SYSTEM –

ORGANISATIONAL SYSTEMS

AND CAPACITIES 51

3.12.1 Supplementing Individual Supervision

and the Linkage with Work-Based

Approaches to Performance

Management 53

3.12.2 Working and thinking in a different way 54

3.12.3 Towards team-based learning,

performance management and

measurement 57

3.12.4 Performance indicators as a

measurement tool 60

3.12.5 Output versus outcome measurements 61

3.12.6 TBPM pilot sites – the lessons learned 62

3.13 CONCLUSION 64

CHAPTER FOUR

RESEARCH METHODOLOGY

4.1 INTRODUCTION 65

4.2 AIM OF RESEARCH 65

4.3 OBJECTIVES 65

4.4 PHILOSOPHIES UNDERPINNING THE

RESEARCH 66

4.5 METHODOLOGICAL FRAMEWORK AND THE RESEARCH PROCESS 67

4.6 PLACE OF STUDY 68

4.7 RESEARCH DESIGN 68

4.8 PRIMARY RESEARCH TOOL UTILIZED 69

4.9 SECONDARY DATA UTILIZED 71

4.10 ACCESS, CONSENT AND ETHICAL CONSIDERATIONS 73

4.11 PILOTING THE INTERVIEW SCHEDULE 75

4.12 ACCOUNT OF FIELDWORK 76

4.13 DATA ORGANISATION AND ANALYSIS 76

4.14 BRIEF REFLECTIONS ON THE RESEARCH JOURNEY 78

4.15 CONCLUSION 79

CHAPTER FIVE

RESEARCH FINDINGS AND ANALYSIS

5.1 INTRODUCTION 80

5.2 SUPERVISORY EXPERIENCES –

THE BIG PICTURE 80

5.3 PERFORMANCE MANAGEMENT –

THE BIG PICTURE 81

5.4 REQUIREMENT FOR AN INTEGRATED

APPROACH TO SUPERVISION 89

5.4.1 Lack of a robust organisational

Mandate and capacity to meet

policy expectations 92

5.4.2 Compromised practice and

Incomplete Supervision 93

5.5 ACCOUNTABILITY AND COMPLIANCE

WITH AGENCY POLICY –

THE PREDOMINANT AGENDA 96

5.6. STRATEGIC REFOCUSING OF THE

PROCESS OF SUPERVISION TO EMBED PERFORMANCE MANAGEMENT 100

5.7. DEVELOPING APPROPRIATE

MEASUREMENT TOOLS 103

5.8. CONCLUSION 107

CHAPTER SIX

CONCLUSIONS AND RECOMMENDATIONS 108

6.1 INTRODUCTION 109

6.2 KEY FINDINGS 109

6.3 KEY RECOMMENDATIONS

6.3.1 Requirement for an integrated

approach to Supervision 112

6.3.2 Accountability and compliance

with agency policy –

the predominant agenda 113

6.3.3 Strategic refocusing of the

process of supervision to embed performance management 113

6.3.4 Developing appropriate

measurement tools 113

6.4 CONCLUDING REMARKS 114

REFERENCES 115

APPENDICES 128

List of Exhibits

EXHIBIT 1 KEY STAKEHOLDERS IN

SUPERVISION AND PERFORMANCE MANAGEMENT 27

EXHIBIT 2 THE PERFORMANCE MANAGEMENT CYCLE – HIGH LEVEL ACTIVITIES 52

EXHIBIT 3 THE PERFORMANCE MANAGEMENT CYCLE – CORE PERFORMANCE MANAGEMENT ACTIVITIES 56

EXHIBIT 4 SUPERVISION OUTCOME CYCLE 58

EXHIBIT 5 THE PERFORMANCE MANAGEMENT CYCLE – TRANSLATION OF NATIONAL PRIORITIES TO UNIT/TEAM BASED ACTION AND PERFORMANCE PLANS 63

EXHIBIT 6 PROFESSIONAL PRACTICE DEVELOPMENT FRAMEWORK 100

EXHIBIT 7 INTEGRATED MODEL FOR

SUPERVISION AND PERFORMANCE MANAGEMENT 102

EXHIBIT 8 EMBEDDING SUPERVISION IN PERFORMANCE MANAGEMENT 110

List of Tables

TABLE 1 TEAM LEADER SUPERVISORY EXPERIENCES 82

TABLE 2 SOCIAL WORKER SUPERVISORY

EXPERIENCES 83

TABLE 3 TEAM LEADERS - PERFORMANCE

MANAGEMENT EXPERIENCES 85

TABLE 4 SOCIAL WORKERS - PERFORMANCE

MANAGEMENT 86

Chapter 1

We are what we repeatedly do. Excellence then is not an act, but a habit.

–Aristotle-

1.1 Introduction

This study aims to explore social workers experiences of professional supervision within the Irish context. There are three critical strands to this research, which examines

(1) The perceptions of social workers in relation to the management function of supervision,

(2) Whether supervision experiences reflect this core function in line with the supervision model set out in the organizational policy on supervision and

(3) How supervision can be linked to an overall robust performance management system with social workers.

Professional supervision is a well-recognized, established and accepted practice in the social work sector located in Irish statutory, voluntary and community settings. Both social workers and team leaders engage in professional supervision on an on-going and regular basis and it is used as a tool in discussing professional practice issues and in the overall management of the work of the social worker. Supervision as a professional practice is now well embedded in the discipline and is generally seen as essential for both practitioners and managers as a way of managing casework issues, caseload management, continuous professional development and managing the emotional impact of the work on the individual. The core business of professional supervision must always be to improve client outcomes (Morrison, 2005). Furthermore the overall functions and responsibilities of the agency in general to the client or service user must be central, critical and a priority in professional supervision. Yet there is very little information available on the perceptions and experiences of social workers on this critical practice[1] and specifically in relation to the management function of supervision.

The purpose of this study is to obtain a contemporary picture of the management function: the strengths, deficits and challenges involved, how this might be used to influence and inform future best practice in the delivery of professional supervision by managers and contribute towards an effective performance management system.

1.2 Definition of Terms

This research has been conducted within the context of agreed definitions and key concepts utilized throughout this research project. Such terms are set out here in order to orientate the reader to their specific meanings.

1.2.1 Professional Supervision

Morrison (2001, p.29) defines professional supervision as

“a process in which one worker is given responsibility to work with (an)other worker(s) in order to meet certain organisational, professional and personal objectives. These objectives are competent, accountable performance, continuing professional development, personal support and engaging the individual with the organisation” (Morrison 2001, adapted from Harries (1987), Richards and Payne (1990) and Butterworth and Faugier (1994).

1.2.2 Performance Management

Performance management is defined as a strategic and integrated approach to delivering sustained success to organisations by improving the performance of the people who work in them and by developing the capabilities of teams and individual contributors’ (Armstrong and Barron, 2000). It is essentially a philosophy and a continuous process to which managers and employees need to devote attention throughout the working year. The critical aims of performance management are to engage in sustainable performance, drive motivation and commitment through developing individual and team potential and act as a lever for cultural change.

1.2.3 Health Service Executive

The Health Service Executive (HSE) was set up on 1st. January 2005, following the introduction of the Health Act 2004. The HSE is essentially the merging of eleven health boards and health authorities into one national and unitary body. The HSE has responsibility for the provision of health and social care services in Ireland. The fundamental purpose or mission of the HSE is to enable people live healthier and more fulfilled lives.

1.2.4 Transformation Programme 2007-2010

The HSE Transformation Programme is a programme of priorities set out to guide staff, managers, service users and all relevant stakeholders on building the momentum for change that has been gathering within the HSE during the last two years since the transition from separate health providers to one national and single entity. This programme for change has been prepared following consultation among staff during 2006 and reflects the views expressed during a series of organisation - wide events.

1.2.5 OPM

The Office for Health Management invited OPM to prepare a report detailing the nature of organisational change in the National Health Service (NHS) over the past fifteen years. Given that the Irish Health and Social Care System had remained largely unchanged for over thirty years, there was little direct experience within it on how to implement system-wide structural change. By contrast, the UK’s NHS has undergone a number of quite fundamental reorganisations over the past fifteen years. OPM’ report included an analysis of the change management approaches that have been used in the reorganisation of the NHS and also observations that were felt useful for and applicable to the Irish Health and Social Care System in managing system-wide change.

1.2.6 Management Function of supervision