BUILDING ON STRENGTHS;
The Development and Testing of a Solution
Focused Approach to Clinical Supervision.
Supervisor: Prof Ken Walsh, Professor of Nursing ISLHD/UOW
Trainees: Karlie Royston
Camillia Spearing
Shoalhaven District Memorial
Hospital
 Located South Coast NSW
 Departments:
ICU, ED, Medical, Surgical, Renal, Rehab, Acute
Stroke, Maternity, Paedatirics, Day Stay,
Operating Rooms.
 Beds:
177
 Facilities:
CT, X-ray, Sonographer.
 Allied Health:
Social Work, Speech therapy, Occupational
therapy, Physiotherapy, Case Workers, Dietician,
Acute pain service, Chronic & complex care
teams, Discharge Support Services, Ambulatory
care, Infection Control teams.
 Nursing Staff:
Registered Nurses, Clinical Nurse Specialists,
Clinical Nurse Educators, Clinical Nurse
Consultants, Clinical Midwifery Specialists,
Midwives, New Graduate Nurses, Enrolled Nurses,
Assistant Nurses.
PROJECT AIMS
 Develop supervision skills in giving and receiving feedback (for
both high performance and below par performance).
 Improve appraisal and assessment skills.
 Enhance interpersonal skills and the ability for self reflection
(for both the supervisor and supervisee).
 Sustain development through co-facilitation, follow-ups for skills
consolidation and ongoing action learning.
OBJECTIVE OF PROJECT
At completion of program, the health service will have a solution
focused clinical supervision workshop to meet the needs of staff
supervising undergraduates, new graduates, and experienced
staff.
To have the potential to expand the program to other categories of
staff such as interns, junior doctors and allied health.
PROGRAM DEVELOPMENT
 Stakeholder engagement focus groups of claims, concerns and
issues related to supervision skills.
 Development of solution focused clinical supervision resources.
 Development of Clinical supervision case senario’s
 Conducting of co-facilitation workshops for clinical skills
development.
 Workshop evaluation
 Follow- up sessions for skills and consolidation with action
learning.
 Post implementation evaluation.
 Report.
What’s wrong?
Complications
The experts know
best
The
Past
Blame
Deficits
Control
Definitions
What’s working
Progress
The Future
Actions
Influence
Collaboration
Simplicity
Resources
Principles of Solution-focused
Approaches
• Work with the person rather than the problem
• Look for resources/strengths rather than deficits
• Nothing happens by chance something makes it happen
• Find out what makes good things happen and do more of it
• Explore possible and preferred futures
• Explore what is already contributing to these futures
• Use creativity and imagination to imagine a better future and work
towards it
• Treat the person as the expert in their own life
(Duncan et al, 2007)
The Solution Focused Shared
Humanity Framework
 Understanding
 Possibility
 Compassionate Action
Understanding
 Understanding self and other
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Psychodynamics
Neurobiological (SCARF) – “Towards” and “Away” states
Engagement (Puzzling)
Motivation
Listening for understanding and possibility
Asking good questions
The solution focused approach: Looking for what works and
strengths
 Solution focused questions
Possibility
 Exploring and Developing Possibility
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Permission and placement
Identifying goals
Solution Focused Feedback for good performance
Solution Focused Feedback for below par performance
Mentoring and coaching “IGROW” model
The assertive option
Compassionate Action
 Values based actions
 Moving from thinking to action
 Making it positive – build self esteem and self efficacy
 Scaling questions
 Build in evaluation / support reflection and feedback
SCARF activity
 Spend a couple of minutes reading the handout SCARF and
YOU.
 Think about which domain is your driver and how that might
influence your behaviour.
 In small groups discuss a recent example of a SCARF domain
being trigger to engage or disengage you or someone else.
 As a class discuss scenarios (handout) with SCARF in mind.
Status , Certainty , Autonomy, Relatedness, Fairness
(The five domains activate with the primary reward or primary
threat circuitry of the brain) (Rock, 2006)
Small group interaction activity
 In threes: one person tells a story, one person listens and the
other observes.
 The listener then summarise the story to show empathy and an
understanding of content, context, emotion and meaning.
 Observer and present give feedback.
 Swap roles and try again.
 For the purposes of this exercise do not ask questions.
EXAMPLES OF “SOLUTION FOCUSED”
QUESTIONS IN THE WORKPLACE
 What changes have you already noticed?
 How would you know things were better…?
 Are there times when you already …?
 If you go to bed tonight and a miracle happens ... How would things
be different?
 Tell me about those times when this problem doesn’t occur. How do
you get that to happen?
 Does that already happen at times?
 What will you have to do to make that happen?
 What will have to happen for more of that to happen?

EXAMPLES OF “SOLUTION FOCUSED”
QUESTIONS IN THE WORKPLACE
 What could others do to help you?
 How have you dealt with ……..in the past?
 When things were better a while ago what was different then?
 How come things aren’t worse – what have you done to stop things from
getting worse?
 On a scale of 1-10 with one being …and 10 being …tell me…
(Walsh, 2006)
16
Some Participant Feedback
 There was loads of information on helping transitioning
nurses in their practice development and my own
development.
 I would like to see it run again so others could benefit and
improve work place culture.
 The examples were appropriate and connected well to the
theory. The research based framework applied to clinical
situations. The plan for follow up interactions to see how we
are applying what has been learned is a good idea.
 Practicing techniques in scenario situations, behaviour is
learned and can be changed, most people are good.
Evaluation of Solution
Focused Component
Selected References
Duncan, L. Ghul, R. Mousley, S. 2007. Creating Positive Futures. BT
Press, London.
Green, J and Grant, A. 2003. Solution Focused Coaching. Pearson,
Edinburgh.
Jackson, P. and McKergow, M. 2001. Harry Enfield, Hamlet and the
Solutions Focus, Organisations and People 8, (1): 26 - 31
Rock, D. Quiet Leadership: Six steps for transforming performance at
work. Harper, New York.
Walsh, K Walsh, K. Moss, C. and FitzGerald, M 2006. Solution
Focused Approaches and their relevance to Practice
Development. Practice Development in Health Care 5 (3): 145155.
QUESTIONS ??????