Individuals with complex health and social needs are trying to navigate broken systems and the professionals who support them work tirelessly to chart what’s often an ambiguous, obstacle-filled path; they deal with setbacks, a lack of resources and frustration on a regular basis. These direct care teams need support and a special kind of mentorship to persevere, avoid burnout, grow their skills, help their patients, and succeed in their careers.
When challenging, ambiguous situations arise, frontline staff members often turn to their supervisors for their help and expertise. Telling them exactly what to do might seem like the easiest solution in the moment, but it’s a temporary fix. When the next challenge inevitably comes along that “fix-it” mindset becomes a rinse and repeat cycle that doesn’t spark professional growth, and instead creates more work for the supervisor in the long-run.
To grow, staff need reflective supervision rather than directive supervision. Instead of telling a staff member what to do, a reflective supervisor strategically guides them in processing a situation and solving the challenges themselves.
When done right, reflective supervision creates teaching moments, builds long-term, sustainable skillsets, and encourages self-efficacy and trust among staff.
Framework for reflective supervision – the coaching quartet
The coaching quartet is a tool that helps supervisors implement the principles and practices of reflective supervision. It’s designed to validate the strengths of the frontline staff member, draw attention to tangible or observable phenomena, reduce defensiveness, and push for deeper learning.
The coaching quartet has four parts that can happen in any order: validation, observation, inquiry, and rationale. These four steps take the supervisor out of the “fix-it frame” of recommendations, directions, and advice and into the reflective frame, allowing the staff member to pause, reflect, and come back with a response.
A reflective supervisor then uses a coaching quartet to continue the conversation.
In this step, the supervisor takes a strengths-based approach with their staff and identifies actions the staff has taken and/or emotions the staff member is experiencing. Recognizing and affirming their strengths, actions and feelings helps frontline staff tolerate the distress that often accompanies complex care.
Example: You’ve worked so hard at building a trusting relationship with this person. Your care and concern for her is evident and has been impactful.
Example: I see you’re working really hard here and you’re making a lot of progress.
This step also allows the supervisor to show empathy. It’s the supervisor saying, “I see you. I know this is hard. Let’s take a pause.” It also grounds the feedback in something tangible for the staff member.
Example: I’m noticing that you’re getting frustrated every time your client doesn’t show up to appointments.
Example: I can see that you are upset — and understandably so. I know you want to ensure that the patient stays safe and continues the path that she started with her substance use disorder treatment.
The question you ask should provoke reflection, insight, and critical thought that can last beyond the interaction. Pairing inquiry with rationale is less likely to elicit defensiveness from the frontline staff member. Pairing them is important, but either one can come first.
Example: What are some ways that you’ve thought about trying to re-engage that person so that they have a better chance of showing up to appointments more consistently?
Example: I’m curious, the next time you see the patient, what is your strategy for talking to them about their readiness to return to treatment?
Supervisors provide a rationale or the “why” behind the feedback, citing research and/or experience. If this part were excluded and the coaching progressed from validation to observation to inquiry, the frontline staff member could feel confused, defensive, or unclear why the supervisor is asking the specific questions. The rationale explains to the frontline staff member why the observation and inquiry make sense and reduces defensiveness. It provides the opportunity for supervisors to provide foundational knowledge or reinforce knowledge.
Example: We know that authentic healing relationships have to be the foundation of our work. When we have that trust, we can get to the root of what’s going on with folks.
Example: Reuse is common for people who use drugs. The path to recovery is different for everyone and often, reuse and disengagement happens. That is part of the recovery process.
Mirroring the practitioner/patient relationship
The relationship between supervisor and frontline staff member should mirror the relationship between the frontline staff member and the patients or clients they work with. Both relationships are designed to help build a person’s skillset so that they can continue to achieve their goals with autonomy.
Rather than a “fix-it” mindset that focuses on what can be done for a patient or staff member, empowering that person to make sustainable change will ultimately reduce burnout and foster better outcomes for all.
Renee Murray is Director of Education and Training at Camden Coalition. Camden Coalition is a multidisciplinary, community-based nonprofit working to improve care for people with complex health and social needs in the city of Camden, across New Jersey, and around the country.