Table 2.

Supportive supervision behavior and skill categories and linked indicators

Behavior/skill category and definition	Observation indicator checklist
Establishes purpose – Communicates the purpose and aims of SPARS and establishes it as ‘supportive supervision’.	✓ Outlines SPARS and its objectives ✓ Outlines the objectives of the visit ✓ Involves the in-charge ✓ Explains the MMS are not here to police but work together as a team ✓ Relates supervision to the bigger picture - patient/ health system/availability ✓ Explains how SPARS will make their work more efficient in the long-term
Identifies problems – Empowers staff to identify problems as areas that need improvement, not as criticism. Discusses causes and has the facility take ownership of the problem.	✓ Follows up on problems identified at previous visit ✓ Asks staff if they are experiencing any problems ✓ Encourages deeper discussion - about the cause or solution to a problem’. ✓ Encourages staff to identify facility problems ✓ Uses performance assessment to identify problems ✓ Prioritizes by focusing on the most important issue
Communicates effectively – Establishes rapport and acts with a considerate, sympathetic, open, and approachable manner. Is confident and competent, not arrogant or authoritative and establishes a relationship with supervisees so they look forward to and not dread MMS visits.	✓ Greets people by name ✓ Voice audible ✓ Jokes/lighthearted conversation ✓ Creates a relaxed atmosphere ✓ Clear and easy to understand ✓ Sensitive and sympathetic ✓ Good eye contact ✓ Not rude, sarcastic, or arrogant ✓ Confident/professional
Promotes participation – Asks questions, promotes discussion, and listens. Assures that supervisees feel their opinions influence the outcome. They should own the program and not feel it is imposed from above.	✓ Acts like one of the team, not an outsider ✓ Uses ‘we’ to discuss issues ✓ Gets supervisees to ask questions ✓ Asks supervisees opinion ✓ Listens ✓ Promotes discussion ✓ Seeks consensus rather than instructing ✓ Makes supervisees feel comfortable and not tense
Interprets data – Collects accurate data and correctly interprets data to assess performance. Uses performance assessment to motivate staff.	✓ Collects data for performance assessment ✓ Explains data collection and how it relates to performance ✓ Links data to performance, to quality of care and benefit to the community ✓ Collects reliable data ✓ Understands how to interpret data ✓ Uses data to identify gaps/ problems ✓ Encourages staff to interpret and discuss data
Solves problems – Promotes discussion and consensus so the facility owns the solution and is committed to implementing changes. The solution should be detailed and realistic.	✓ Discusses the cause of the problem ✓ Involves supervisee - asks about their suggestions ✓ Provides accurate and constructive advice ✓ Suggests realistic solutions ✓ Makes innovative and creative suggestions ✓ Involves relevant people required to ensure the problem can be solved ✓ Proactive—offers to follow up with decision makers
Uses tools – Uses SPARS tools and practices appropriately to ensure an objective and reliable supervision process that motivates supervisees and helps them understand priorities and expectations. Uses SPARS data collection tool, fills in the supervision book, sets targets, and fills out the spider graph to illustrate performance and achievements.	✓ Uses the data collection tool with SPARS indicators ✓ Leaves a copy of the data collection tool at the facility ✓ Displays the spider graph at the facility ✓ Seeks supervisees views ✓ Writes feedback in the supervision book ✓ Writes targets in the supervision book ✓ Gets the in-charge to sign the supervision book ✓ Updates the spider graph ✓ Uses the performance assessment as a tool to motivate supervisees
Sets targets – Jointly prioritizes realistic targets and makes implementation plan to address identified problem areas to ensure genuine commitment to improvement. Records targets in the supervisory book and follows up at next visit.	✓ Talks about targets agreed at the last visit ✓ Sets targets to complete by next visit ✓ Targets are specific, measurable, accurate, time bounds and realistic ✓ Agrees on targets with staff ✓ Sets timeframe to complete ✓ Sets targets based on performance assessment weaknesses ✓ Gives them tools, strategies, advice, or innovations
Educates –Allows adequate time to educate and instruct supervisee. Demonstrates, uses examples, and provides reasons to ensure the supervisee understands and can implement changes on his or her own. Is patient, clear, and persistent.	✓ Prioritizes time to build capacity (doesn’t just collect data) ✓ Identifies gaps in skills and knowledge ✓ Gives training when it’s needed ✓ Physically demonstrates a task ✓ Gives full explanations ✓ Gives concrete, relevant examples ✓ Ensures supervisee understands, have them demonstrate their understanding ✓ Patiently repeats if they do not understand ✓ Provides correct information and training
Provides constructive feedback – Conducts a formal feedback session on performance and targets with facility staff, supervisee, and In-charge at the end of the visit. Provides reasons not rules and encourages discussion to promote ownership.	✓ Gives feedback based on evidence from the performance assessment ✓ Involves appropriate staff and in-charge in feedback if available ✓ Praises where appropriate ✓ Provides diplomatic, tactful, and constructive correction where appropriate ✓ Does not only finds fault ✓ Gives reasons rather than rules ✓ Motivates—provides incentives for change ✓ Doesn’t overwhelm
Assures continuity – Focuses on continuity to ensure ideas for improvement are not lost. Is mindful of facilities’ priorities and workload when scheduling. Follows up on the previous visit and sets dates for the next visit.	✓ Does not arrive unannounced ✓ Discusses previous visit ✓ Sets a date for the next visit ✓ Discusses what needs to be done before the next visit ✓ Has staff confirm what they will do before the next visit ✓ Gives an idea what the objectives will be at the next visit