I am reviewing patient safety, human factors and system design as part of looking at our investigation processes. In reviewing our past investigation reports and thematic reviews, it is apparent how people struggle to see the world in a different way and have to respond to the constant addition of new risk assessments, templates and multiple processes – surely no-one can remember them.
As part of our Wisdom Academy, we are reflecting on how can we create educational content to support continuous improvement and our personal learning journey. At the heart of this is the art of reflection. We need to be able to consider ‘being wrong’ without the emotionally feeling of punishment and failure. This is usually generated from within – even where our coaches and supervisors are telling us how great we are.
This focus on risk management through risk assessment checklists, policies and procedures aims to minimise “practice mistakes” which are seen as consequences of professional judgement and action. These prescriptive processes represent rationality and is perceived to be effective in managing uncertainty and unpredictability. This is considered to minimise or eradicate “practice mistakes”. Professionals are expected to adhere to procedures leading to accountability to the organisation rather than doing the right thing in the moment.
Uncertainty is not valued in our systems and we are taught frameworks that believe in right and wrong answers, yet we live in an uncertain world where decisions need to be made based upon our experience, emotional responses, intuition and instinct and is a skill which needs to be practiced.
So this blog is to think about how we view the world, make decisions and are able to look at things in new ways using supervision as a forum to develop this talent.
We are complicated!
Our brains experience the world but then we have to pay attention against a massive background of distractions.
We have to make sense of complexity recognising that the world is unpredictable, has multiple interfaces and the passage of time exposes new realities.
Then we have to reason and make decisions with multiple frameworks, personal, professional, organisational and within systems and legislation and take action.
This then forms our memories and becomes part of our formula for pattern recognition when exposed with the same situation next time.
We need to remember however, when we are learning, we rarely have the knowledge of the consequences of our actions. We move through roles and organisations only looking forward and often feel we are a failure when we discover we made an error or that a series of events lead to a negative outcome of which we were a part.
Supervision Styles
Supervision, which is an overused word, is a safe space for us to discuss our actions, thoughts and feelings and how we can consider different options. In work, it is also being used to monitor our tasks, challenge our competencies alongside looking after our emotional wellbeing.
Supervision is presented as a timeline of events without emotion and feelings, with a comparison of our own practice to known policies, procedures and the evidence base acknowledging our wrong doing (if we are observant) and promising we will not do it again.
Restorative supervision has been designed to create a safe space but if the supervisor struggles to see the world in different ways, even when creating a safe space, it will not create new possibilities. It is still valuable as a place to provide an emotional outlet which will increase our ability to learn, but if we continue to use the same decision making framework, we will be unable to move forward.
Decision making and action involves connecting with others and interacting with our environments influenced by a million variables and the complexity of humanity.
So what next?
We need to have the knowledge and awareness of how we all have different perceptions of the same events and allow difference of opinion to occur. We need to accept inconsistency and the experience of not knowing the answer to be normalised.
The definition of reflective practice is to explore an experience and identify what your role in the experience including your behaviour, thinking and related emotions to be able to create patterns for the future to be a confident practitioner.
What, where, and who—the situation
We need to think about the situation in detail: What happened exactly and in what order? What part did you have to play? What was the final outcome?
How did it make you feel—your emotional state
We are becoming familiar with the opportunity to discuss our emotional responses. What was running through your head and how did you feel about it? We need to be honest: were you afraid, confused, angry or scared?
Why did it happen—making sense of the situation
This is clearly the key to personal growth. By thinking about the situation in greater detail enables you to recognise things that would have otherwise gone unnoticed and enables you to explore the reasons for why the circumstances played out. Currently, this rarely recognises the context, alternative options and the role our systems play in the outcome.
This additional layer in making sense of situations is captured in the concept of reflexivity, which looks at where the actions taken came from? Reflexivity is felt to be valuable in professional practice, particularly in relation to working with uncertainty and as an important feature of ethical practice which addresses the reason why?
Could you have done anything differently requires critical review and development of insight to create change and allow the bigger picture to emerge.
In order to reduce the stress in our environments, we need to re-discover the skill of professional discretion, judgement and autonomy to address the complexity of our environments and discuss the tension between theory and practice.
Self-confidence is required to engage in critical or reflexive approaches to autonomous practice, critical thinking and experimentation. We need space to analyse and think creatively of different options.
Expanding our questions
So by expand the building blocks to break down our role in a situation, I propose the following questions to ask yourself.
- What was I paying attention to?
- What was going on that I was not aware of and do I have a sense of this?
- What did I feel and was it a stress response?
- What was my mind thinking?
- What was my body doing?
- How was I connecting to others?
- What was I saying?
- Was this in any way related to knowledge that I have been taught or acquired somewhere?
- Was this in any way related to processes, procedures, custom and practices which I followed?
- Was this in any way connected to wanting to do what others wanted or rebel from what others wanted?
- Who held the power in the relationships?
- Who else has relevant ideas and what would they say?
- What did the context tell me – what is the unknown or the surprise?
- Did I use my imagination to identify a way forward from first principles?
- Did I use intuition and felt it to be right or wrong?
- How did this align with my values – did it feel fair or unjust?
The final question we need to explore is the most difficult.
- I would propose that we need to take a different position and identify what this could look like and create a debate that makes our alternative version, the correct approach to build our ability to see other perspectives and understand our assumptions better when we make choices.
Using a wider questioning technique allows us to understand our experience, discuss our ability to self regulate and analyse the options available to us. We have the capacity to learn and adapt. It also allows us to participate in organisational improvement and enable professional challenge and sharing of ideas for doing something better.
Our Emotional Responses
Just to remind ourselves about emotionally self regulation, it is important to remember when we scan our environment, we have an emotional reaction and this is normal. We are wired to recognise patterns and respond and have a primitive reaction to rejection and stress which triggers our fight, flight, fight response.
As practitioners, my experience of supervision and reflection, is that we view the world as a third person observation, detached from the events. Reconnecting with our emotions is an important element to consider.
Psychological safety is an important underpinning principle for supervision and learning.
We often discuss empathy for others and responding compassionately to distress but we also need empathy for ourselves and to accept our vulnerabilities without fear.
We need to understand that trauma, loss and making errors alongside positive outcomes enhances resilience and deepens wisdom and personal growth.
Hiding our flaws behind a carefully curated mask is not only stressful but also undermines our own perspectives and creates an internal tension, which is seen in burnout and compassion fatigue.
Sense Making
Sense making is critical to reflection and self improvement but is often overlooked in our discussions.
We need to identify how we understand our own minds, the minds of others and the eco-systems we exist in.
Through this process of active open mindedness, using reflection to balance view points, explore options, and aspire to change, we can create understanding.
We need to value the acceptance of imperfection, the unknown and mystery alongside the facts, application of knowledge, wider perspectives and context to enable synthesis of ideas, creating experiences that allow us to be flexible and adaptable when needed.
The Meaning of Supervison
All forms of supervision are important in our roles but rather than confuse operational capability, emotional wellbeing and competency assessment, we need to name these interactions correctly. To develop further, we need to form a safe space for our learning journey which can be labelled as such.
This safe space is where we can discuss uncertainty and build new decision making frameworks based upon our experiences, emotional responses, intuition and instinct.
Through self discovery and practice, we will embed our ability to make decisions, explore our landscape of options, recognise when we can use our own intuition or connect with others to share ideas and knowledge.
Mastery of decision making in complex environments requires endurance, dedicated time and continuous effort. It takes hundreds and thousands of repetitions, trial and errors. Then through our growth mindset, we can discover our untapped potential.
