Over the past 32 years I have trained tens of thousands of clinical supervisors and wanta-be supervisors. As valuable as that training might be, the real test of whether an organization has a quality system for clinical supervision is not at the phase of training supervisors but at the implementation phase.

So, for the next few columns I will provide a roadmap for supervisors and administrators in the steps to implement a clinical supervision system. Future columns will address the steps to implementation and the roadblocks and how to overcome these barriers. (Throughout these columns we will speak of it as “a system” because a quality clinical supervision program impacts on many aspects of the organization, from clinical oversight, personnel appraisals, quality assurance programs, to research and program evaluation).

Assessing the organization’s readiness

The first step is to determine the degree to which your organization and its staff are ready to implement a clinical supervision system. The Change Book (ATTC, 2004) is a good place to start to review organizational change processes.

The assessment of the organization’s readiness for change includes a number of variables: the agency’s context; clinical skills of staff; organizational integrity; motivation; the quality of the supervisory/staff relationships; environmental factors (e.g., financial, accreditation, legislative mandates); and the best supervision approaches to match the agency’s goals and objectives. Even as a counselor might assess the client’s stage of readiness for change, so should an organization assess its willingness, motivation and readiness to implement supervision.

Further, management needs to be clear as to what it wishes to accomplish, and assess its understanding of what’s involved in setting up a clinical supervision system. There are many tools available to assist in this process, including the new Treatment Improvement Protocol on Clinical Supervision, due out in 2009. There is no need to reinvent the wheel when an agency elects to improve its supervision system; many forms and tools already exist, which can be utilized from public domain sources.

To begin, here are some questions management needs to ask as an initial assessment of the organization’s readiness:

• What are the goals of the organization? To what extent does staff understand and match these goals?
• What is the organization’s formal and informal hierarchical structure? Who makes decisions? How are these decisions made? How open is the organization to ensure that all staff are respected and treated as valuable members of the clinical team?
• What systems for continuing staff education and training are in place? How sound and effective is the staff performance appraisal system? What are staff’s opportunities for growth and professional development?
• What are the organization’s current challenges (staffing, management, financial)?
• What are the staff’s current levels of proficiency (attitudes, skills, and knowledge)?
• What resources (time, financial) are available to implement a clinical supervision system? What additional resources are needed?

Even as a clinician would assess the client’s stage of readiness, management should ask itself if the organization is at the pre-contemplation, contemplation, preparation, etc., stage of readiness. For example, how aware is the organization of the need for clinical supervision? To what extent has management considered this need? Has a plan of action been designed as yet? What stage of implementation is the plan? What resources are available/needed to maintain the implementation plan?

Further, the stage of readiness of all levels of the organization needs to be assessed, from the Board of Directors, executive management, administrators, supervisors, line staff and support staff. What are the expected outcomes and timeframes for implementation of a clinical supervision system? What are the organizational, administrative, clinical and other barriers to implementation? It is helpful to list the important barriers to address within the first three months of the plan. What would management like to see happen as a result of the supervision system? Who is needed to participate in the system and who needs to be enlisted to effectively implement quality clinical supervision? What additional resources are needed — training of supervisors, presentation of the system to staff, hardware, such as videotapes, cameras, one-way mirrors, audiotaping equipment, etc? What are the legal and ethical issues to be addressed, e.g., permission forms for videotaping, informed consent information for clients and supervisees, etc.?

Once a thorough assessment of the organization’s readiness to implement a clinical supervision system has been conducted, the next step is to receive full support from senior management to implement the system. This is best done in both written and verbal form to all personnel. Staff needs to hear loud and clear that we are serious about having quality clinical care and clinical supervision is an essential ingredient to ensure care. They also need to hear that the new supervision system is not the “current flavor of the month,” which will go away when the CEO attends the next conference and returns with another hot new idea. Sometimes staff “waits us out,” believing that “this too will pass.” Staff needs to hear that supervision is an ongoing process and is here to stay.

In future columns we will address the next steps to implementation. For further information on implementation of a clinical supervision system, contact David Powell at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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