Ajay Bhatt 00:05
Hello and welcome to Advanced Practice Weekly. My name is Ajay Bhatt and welcome to the program. Today I’m joined by a very special guest. She’s back here by public demand. Debs Harding, welcome to the program again. Thanks for coming back to talk to us today. We’re going to introduce a concept that you have created.
Deb Harding 00:28
I suppose it’s something that fell out of my PhD research. I don’t know if that’s the very academic way of describing it, but it’s a framework that I think is useful for us unpicking those complex, naughty problems that often come to supervision and identifying the different dimensions of it.
But yeah, it came about as I was talking to more and more people in my PhD research and realized that the things we’re concerned about in practice aren’t just our clinical knowledge and skills or our clinical experiences, but it’s that weave of things that happen outside of work that might influence how we are navigating practice concerns, but also our behaviours, our characteristics, our preferences, our personal qualities. And they’re quite difficult things to talk about in supervision because it starts to feel a bit judgey. So this gives us a framework that allows us to look at that whole weave in a helpful way, I think.
Ajay Bhatt 01:34
Great. And the reason I’ve been fortunate enough to have some training from Debs over the last few months in my other role and have been able to share this platform with some of my colleagues. And when Debs first presented it to us, we looked at it and thought this is a really nice concept or a way for us to help us within our own clinical supervision. So Debs, do you want to just break it down for us and talk to us about its individual component parts?
Deb Harding 02:01
Yeah, okay. So I call it a platform for practice because I think this is this thing we kind of stand on. It underpins everything that we do in practice. And it’s a combination of our knowledge. So that’s our expert clinical knowledge or specialty knowledge, our profession-specific knowledge and so on. It’s our skills. So those knowledge and skills which are a bit like Proctor’s formative stuff that colleagues who are familiar with Proctor’s model will remember.
And then it’s our experiences, but not just our experiences in practice, in work. It’s also our experiences outside of work. So let me give a little bit of an illustration of that. If I am the go-to oncology occupational therapist in my team or in my organization where I work, and I’m really solid with my knowledge and skills in oncology, but someone very close to me is now navigating their own cancer journey. And so those experiences outside of practice might kind of contribute to some of my reflections and the way I feel or how secure I feel in my own practice all of a sudden, because I’m thinking about the way maybe colleagues are talking to my loved one and thinking about things that I thought might work and land well with my patients, but haven’t maybe landed so well with that loved one.
So I start examining my knowledge and skills still really solid. I start questioning some of my practice because of what’s happening outside of work. So there’s that sort of example, but there’s also, and in my research, what was interesting that I hadn’t really occurred to be before. So many things that occurred to me in my research, I thought, how have I never noticed that before? But things like, I don’t know, colleagues who are trained as sports referees, for example, and how they bring some of that knowledge and experience of maybe conflict resolution on the football pitch on a Sunday morning to their supervision and also to their practice, their understanding and their interactions with people. So I think we’re missing a trick if we don’t add in that experience outside of practice in this platform for practice. And then as I said, there’s these behaviours, characteristics, personal qualities and preferences.
And that can be things like, if we’re honest with ourselves, we may be a bit perfectionist. That’s not me by the way, but if you’re a bit of a perfectionist person or you’re a bit more chaotic, you’re a bit hurry up quick, you’re maybe a bit oversensitive, you’re a bit over-sharey, you may be very chatty, all of those personality things, those characteristics, influence and shape and flavour, the sort of practitioner that you are. So again, if we’re not finding ways to talk about those or recognize those in supervision, we potentially are missing a bit of a trick. We could tackle all the knowledge and skills stuff, but we haven’t tackled some of the bits that are to do with our behaviours or something that’s going on in our life outside of work.
Deb Harding 05:20
Then all the knowledge and skills work in the world is not gonna move us forward with our concern. So that’s the kind of components of the platform for practice. And then as I say, what happens in any given clinical scenario I suggest is that we foreground or background different dimensions of that platform depending on what’s in front of us. So sometimes we really know we need, it’s a complex diagnosis, maybe comorbidities, and we’re using a lot of our knowledge to weigh up what different aspects of the diagnosis or the clinical presentation are contributing and why.
So that’s a real knowledge-y thing. We might be, and often use the example, might be a respiratory physio who has a caseload of patients. I’ve seen the previous day and I’m going back to see them today as part of my practice. And there’s one person who I’m thinking, well, I did some exercises with that person yesterday that really seemed to help their respiratory function. They were a lot more comfortable afterwards. I think I’m probably, when I get to that bedside, I’m probably gonna do the same things again. But when I get there, maybe the ward round has just been round, that person has had less optimistic news about their prognosis than they’d anticipated. And they’re emotionally really not in a great place.
So I might background what I thought I was gonna do knowledge and skills-wise and bring more of my personal qualities to the preferences, to the fore, and actually sit and spend time and listen to that individual, perhaps offer to go back later to do the exercises. But in doing so, when I get back to write my notes, I might have a bit of uncertainty about whether I should really have just pressed ahead with those activities that I had been planning in the first place. So I hope that kind of gives you a bit of a flavour of how those things work.
Ajay Bhatt 07:24
Yeah, I think, so if you can, for our listeners, if you can imagine it, it’s in like sort of four columns. And so it’s knowledge at the beginning, then skills and experience in and out of work, and then behaviours, characteristics, personal qualities and preferences.
And what we’ve done now since having been taught about this platform to practice, we’ve now started using this when we’re giving feedback to our practitioners after having supervision, because it’s a really nice way to lay it out, because we can, we can break it down into its individual components. If we have a practitioner who’s seeing a patient, we can say to the case that this, these are the areas in the knowledge that were hit really well, we did this really nicely, but we didn’t quite do this as well. The skills are fantastic.
And then we can get into the experience in that, you know, so this area here, what changed you, your conversation wasn’t quite right, you, you have you had any experience in dealing with these types of patients before, have you, has anything in your own life caused any issues with this type of patient, and then we can get into your behaviour and characteristics or someone’s become a bit more quiet or they become very loud, but it gives you the opportunity to pick up on things that you probably would potentially avoid in feedback normally, because they might be uncomfortable to talk about, especially about behaviours and characteristics.
Deb Harding 08:35
Yeah, that’s great to hear. And also what I pick up about what you’ve just suggested there, AJ, is it gives you an opportunity, I think, because you’re looking at all those dimensions, you know, even if someone’s had a tricky clinical interaction that you are supervising, it gives you the opportunity to pick out some things that have gone well, and to say, so these are the bits that are going well, like, how can we build on those?
Because it doesn’t end up in a kind of, you know, if you don’t have some kind of framework to work with, I think it’s very easy to get into that deficit model, both for you and the supervisee, where you end up focusing on what didn’t go brilliantly. And this gives an opportunity to highlight some things that are strengths and can be built on.
Ajay Bhatt 09:19
And it breaks it down into nice bite-sized chunks and it definitely makes it a lot easier for the supervisor to be able to break it down into those specific areas because otherwise sometimes it can all become a bit of a mishmash and a mess because you’re not quite sure.
Was it a knowledge gap? Was it a skills gap? Is there something else in the background going on? Is it just a behaviour? But this way we can actually break it down into its individual components. So we found it really useful to use this in supervision with our colleagues because it’s enabled us to give feedback.
Deb Harding 09:51
slightly more structured and also something you can revisit in a subsequent supervision. You can identify some things to work on and then go back to revisit them in a subsequent supervision. I think what you said there about how the concerns we have in practice can be really messy and intertwined as well. So I think you’re describing a scenario where you as a supervisor might have been with the supervisee in practice, but you also have those supervisions where someone brings something to you that you haven’t seen them do.
They describe a kind of scenario that they’re concerned about. Maybe the sort of supervision we have that’s outside of training, but more our ongoing supervision as a qualified registered practitioner. And it’s very difficult sometimes to know where to start with that. But having this sort of frame and saying, so what aspects of this are about knowledge? Which bits are about your skills? Is there something happening outside of work that might be influencing this? You might not want to tell me about it as a supervisor, but it’s kind of highlighting to the supervisee.
Don’t forget that some things that happen outside of work might have an impact. And if they are, it doesn’t again doesn’t have to be me as a supervisor who supports that. But I kind of have a duty of care to you as a fellow professional to say, if there is stuff, where is it going? And is there anything we can be doing as an employer to support you with that? And I think it also potentially opens up a possibility for us to have some of the conversations. Again, not everyone always knows, put myself in that space too. We don’t always know how to have the EDI conversations. So where there might be protective characteristics or learning difference. Again, this allows us to highlight that and say, well, maybe that’s something we should be paying some attention to if we want you to be the safest professional that you can be.
Ajay Bhatt 11:48
Definitely. And I think also the experience is one is really interesting because if you I’ve had colleagues who have had a lot of experience with dealing with things like dementia through their own family and friends. And then when you see them with a dementia patient, they’re amazing. And you’re like, wow, where have they got all these skills from?
And then when you do the feedback and you sit down and you say to them, well, how come you know so much about dementia? They’re like, well, actually my grandfather had it or my father had it. And I looked after them for years. All of a sudden these new skills come out, which you weren’t aware of, which we can then tap into as an organization to help train the rest of our team that doesn’t have as much good knowledge in dementia, for instance. So it’s been it’s been really useful from that perspective as well.
Deb Harding 12:25
bring an example of how we can value all of our learning. And again, we get quite fixated on where learning happens. And we sort of have these assumptions about learning happening, you know, in classrooms with a kind of nominated educator.
But that example of the incredibly rich knowledge and skills that come from some quite, you know, that personal experience is incredibly valuable. And again, this gives that opportunity to acknowledge that and give it some to give it some currency in your professional portfolio, which I think is really, really vital.
Ajay Bhatt 13:07
Yeah, and we really do try to tap into those people that have got those little bits of expert knowledge about specific things because you know then then we can share that knowledge and that’s really important for everybody so that works really well for us.
Deb Harding 13:19
I suppose there’s another thing I would just add is that, so I know we’re talking about this in the context of supervision, but I think I notice it can be valuable. And actually colleagues will see a kind of version of this in the Centre for Advancing Practice Workplace Supervision Guidance, where it’s about thinking about all the, when you’re thinking about the cohorts of patients, the public that you are working with as a practitioner, and particularly when we’re working maybe in less familiar roles or less familiar settings.
Think about what are all the patients I would see in my role? What sorts of knowledge, skills, experiences, behaviours will serve me well? Well, what’s that platform for practice need to look like so that I can work with these individuals? So it can help to inform learning plans, it can help to involve looking, it can help to inform looking at skill mix.
So if you’re a team leader and you’re thinking, it sort of takes you a little bit beyond your knowledge and skills that you might have on a person’s spec to think in a slightly richer way about what your different team members can bring together and in order to make your service, the rounded service it needs to be. So as an idea, I think it can be helpful in more than just supervision, it can support that kind of workforce analysis as well.
Ajay Bhatt 14:46
Yeah, I never considered breaking it down into that kind of process, into like a sort of a team, team base, because you can, I guess you can then look at it and be like, who’s got the skills, who’s got the knowledge, who’s got the right behaviours.
Deb Harding 14:58
So you can use it as a team kind of activity, so you might all come having, you might have what you think the platform for practice looks like for your band sixes and your band sevens and your different colleagues across the team. But then you might ask individuals to say, well, how does your individual, because everyone’s platform for practice will be slightly different, because everyone’s experiences outside of work and behaviours and whatever will be slightly different, but it can help for us to understand who brings what to the table. And it can also help for us to understand where we might want to focus our learning and development priorities as well.
Ajay Bhatt 15:37
Great. That’s another use for the platform for practice, which I didn’t consider. So there you go. Debs Harding, thank you so much for joining us today on Advanced Practice Weekly, a nice short one for everybody just to quickly listen to for about supervision and the platform for practice. You can find more information on this at Deb’s website, the Permeable Practitioner.
Deb Harding 15:55
permeablepractitioner.com. It’s not the busiest blog on the planet, but there’s lots of free resources there for you to take.
Ajay Bhatt 16:03
Thank you so much everybody, take care, be safe and we’ll see you again shortly. Bye bye.