Clinical supervision was perceived by supervisees to be effective overall. All professions with more than ten responses had MCSS-26 scores above the threshold score for effective clinical supervision of 73. There was variation in the effectiveness of clinical supervision across allied health professions. While the overall results were similar to those reported in other allied health studies using the MCSS-26, the score for speech pathology was higher than in previous studies (13, 28, 29). This novel finding, contrasts with previous studies, where the professions with the most effective clinical supervision were those counselling-based professions with more established traditions of clinical supervision, such as social work and psychology (13, 28). The lower score for physiotherapy is consistent with several other studies (13, 17, 18). This may be explained by other research findings where physiotherapists reported greater satisfaction when direct models of clinical supervision are used rather than a mix of direct and reflective clinical supervision (30, 31) which was the predominant model used by physiotherapists in this study.
The effectiveness of clinical supervision in this study was influenced by the level of experience and seniority of the clinical supervisor. Clinical supervision was most effective when provided by a senior clinician (grade 3) and least effective when provided by a manager. This finding builds on existing evidence that clinical supervision should be separated from line management to prevent blurring the boundaries of these functions and clinical supervision becoming overly focused on administrative functions (15, 21, 32–34). Additionally, there is a power differential when a manager is the clinical supervisor which may result in “supervisee guarding” where supervisees avoid discussing issues around work skills and performance for fear of being viewed as incompetent (35).
Managers should also participate in clinical supervision that is separated from operational accountability to enable them to access professional support and maintain and develop their own clinical supervision skills. Strategies suggested by participants in this study to address this issue included implementing peer group models of clinical supervision for senior clinicians which could ensure that clinical supervision is separated from operational issues. Another potential strategy was exploring cross-organisational models of clinical supervision for senior clinicians and clinical managers. This could enable experienced clinicians to source clinical supervision that is relevant to their clinical speciality or role and promote sharing of evidence-based practice between organisations. Facilitating cross-organisational approaches would require the development of coordinated state or jurisdictional clinical supervision policies to address issues such as establishing registers of clinical supervisors and cost-sharing between organisations.
In this study, another factor associated with increased effectiveness of clinical supervision was where supervisees had chosen their clinical supervisor. The theme of clinicians wanting to have input into choosing their supervisor was present in responses from participants suggesting improvements for clinical supervision at the health service. This finding is consistent with the recommendations made by other researchers as best practice clinical supervision (36, 37). Aside from social workers who had a process for enabling supervisees to choose supervisors, the health service’s model of supervision was based on hierarchical allocation of supervisors within the same profession and speciality. This is a similar model of supervisor allocation reported within health services in other allied health clinical supervision studies (13, 28). When discussing this finding, the action research group determined that it was not practical to enable all staff to choose their supervisor within the existing allied health workforce structure in this health service. This perspective is supported by a study involving allied health in community health settings that reported that workforce structures containing insufficient numbers of senior clinicians was a barrier to accessing and allocating clinical supervisors (11). However, it may be possible for some clinicians, such as experienced clinicians or those who have had the same supervisor for an extended period, to have input into the choice of their supervisor.
The overall MCSS-26 score in this study for the health service was the same as the score reported in the 2015 study, indicating that the overall effectiveness of clinical supervision was maintained during the 5 year period between surveys. There were minimal changes in the domain and sub-scale scores with the sub-scales relating to the importance of clinical supervision and its role in assisting reflection scoring higher in both surveys and finding time for clinical supervision scoring the lowest in both. The lack of change in overall effectiveness of clinical supervision, despite the increased focus on clinical supervision, could be associated with clinicians having a greater awareness of the benefits of clinical supervision and therefore having higher expectations for clinical supervision.
For some individual professions there were changes in scores between surveys. While the 2015 study did not include enough responses from speech pathology to enable this profession to be analysed individually, the high score for speech pathology in 2020 was notable. There was also a modest increase in the score for physiotherapy. Neither of these professions had structured frameworks for clinical supervision in place prior to the implementation of the organisational framework in 2015, which may have contributed to the increased effectiveness of clinical supervision for speech pathology and physiotherapy.
Participants perceived that the organisational framework specified expectations for clinical supervision and provided a structured approach. In contrast, social work and occupational therapy, who did have existing frameworks in place prior to the introduction of the organisational framework, had no change or a slight decrease in their MCSS-26 scores. Previous studies have recommended that structured frameworks for clinical supervision are required to improve the quality of clinical supervision (17, 18). However, this study is the first that the authors are aware of to provide a longitudinal comparison of the impact of implementing a clinical supervision framework for allied health, demonstrating that such initiatives can have a positive impact on clinical supervision. This finding strengthens the need for future policy direction to focus on the development of common allied health clinical supervision frameworks to facilitate consistent approaches to clinical supervision implementation and education.
Whilst the response rate in this study was 50%, it was within the range of response rates reported in other studies using the MCSS-26 survey (16, 28, 29). However, the low number of responses in some professions restricted the analysis of comparison between groups and there may have been a positivity bias amongst those who responded. Additionally, the ability to draw conclusions when comparing the 2015 and 2020 survey findings was limited as a formal pre-post design was not used, consistent with recommendations for the use of MCSS-26 and an action research approach.