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Shaping innovative services: Reflecting on current and future practice
88
JCPSLP
Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
Abigail Lewis
(top) and Joanne
MacDonald
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
SUPERVISION
REFLECTION
PRACTISING
SPEECH-
LANGUAGE
PATHOLOGISTS
workforce; increasing numbers of part-time staff; and
the longer training required to prepare professionals for
increasingly complex roles (Crettenden et al., 2014; Mason
& DHA, 2013; May, 2015). To compensate, substantially
increased numbers of health students have been enrolled
into university courses (Health Workforce Australia, 2013),
leading to the need for increased clinical placements in the
workforce and an influx of young graduates also requiring
support and supervision (Speech Pathology Australia [SPA],
2014a).
Meanwhile, Australia’s population is ageing, experiencing
more chronic disease, and thus requiring increased
multidisciplinary involvement and more preventative
health care (Mason & DHA, 2013). The model of western
health care is shifting from a medical to a biopsychosocial
model, increasing the focus on quality of life (Bakas et
al., 2012), and the expectation that the health workforce
engage in a relationship focused client-centred approach
to delivering services (Borrell-Carrió Suchman, & Epstein,
2004). This model of service delivery requires sophisticated
interpersonal skills and an understanding of the therapeutic
relationship: mindful openness to the client’s experiences
and emotions; empathy; self-awareness; and management
of the power imbalance in the relationship (Borrell-Carrió
et al., 2004). The client – health care worker relationship is
central to intervention (King, 2009b).
The health and disability sectors are transitioning rapidly
to activity-based funding models (Eagar, 2011; National
Disability Insurance Scheme [NDIS], n.d.). This move
away from block funding for services provides incentive
for patients to be discharged sooner (Eager, 2011). The
roll out of the National Disability Insurance Scheme means
clients have funding to purchase required services from
providers, further increasing the significance of the client
– health care worker relationship, as complex negotiations
around services and health care decisions are tackled. An
additional outcome of this change is a dramatic increase
in the number of private practitioners, with over 50% of
speech-language pathologists (SLPs) now working in
private practice (Hutchinson, 2015) and increasing numbers
of new graduates moving directly into private practice.
While many of these pressures have long been predicted
(McAllister, 2005), they occur in the context of Australians
continuing to expect quality health care services from highly
trained professionals. How can the workforce deal with
these challenges and continue to provide quality care?
Mason and DHA (2013) suggest that “a continued focus
on allied health networking, adequate supervision and
The health landscape is rapidly changing with
health professionals needing to adapt to new
and emerging environments, while still
providing quality health care. Access to
appropriate supervision can enable the
workforce to deliver high-quality health care
by supporting the development of knowledge
and clinical skills in supervisees, thus
improving client outcomes and reducing
clinician stress and burnout. Recently,
Speech Pathology Australia has been
emphasising the importance of supervision
for speech-language pathologists with new
publications and website resources.
Empirical evidence of the benefits of clinical
supervision specifically for speech-language
pathologists is largely lacking in the
literature. This paper draws on relevant
literature from other professions to build a
case for the need for all practising speech-
language pathologists (SLPs) to receive
regular clinical supervision. From this
literature a framework for undertaking
supervision has been constructed,
recommending a focus on reflection and
relationships. Key points support SLPs in
their implementation of supervision, to
optimise the benefits and outcomes. A future
article will more specifically explore
supervision for students.
T
he Australian health workforce is faced with
significant challenges: a predicted shortfall of staff,
Australia’s ageing and changing population, reduced
access to health care for some groups, changing models
of health care concomitant with shifts in funding, and a
substantially increased number of student placements
required for the training of new generations of professionals.
Government modelling has predicted a significant shortfall
across all disciplines by 2025 (Crettenden et al., 2014;
Mason & Department of Health and Ageing [DHA], 2013),
arising from a number of factors including: the ageing
Supervision
Vital for speech-language pathology
Abigail Lewis and Joanne MacDonald