Summary of - Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review.

Title of Original: Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review.
Authors: O’Donovan R, De Brún A, McAuliffe E
Journal: BMJ Open, 2021
DOI: https://doi.org/10.1136/bmjopen-2021-052929

Why This Matters - Clinical supervision is vital across mental health, nursing, and allied healthcare—but it often fails in practice. This review identifies what makes supervision effective (or not), offering a practical foundation for therapists, clinical leads, and supervisors seeking to build sustainable, supportive supervisory relationships in real-world settings.

Read Time - 5 Minutes

This rapid review explores the enablers and barriers to effective clinical supervision in healthcare workplaces, with a focus on allied health, nursing, and mental health settings. Although clinical supervision is widely recognised as essential for safe, reflective practice, evidence on how to make it effective is fragmented and often not applied.

The authors reviewed 16 papers from 2010 to 2020, including qualitative studies, reviews, and mixed-methods papers. Using a thematic synthesis approach, they extracted key enablers and barriers into four overarching themes.

1 - Organisational Culture and Support

Enablers:

A culture that values supervision and integrates it into the work environment
Protected time for both supervisors and supervisees
Policies that formalise supervision as part of staff development

Barriers:

High workloads and staffing shortages
Lack of managerial support or buy-in
Supervision viewed as a tick-box exercise rather than a developmental process

The organisational climate was repeatedly cited as a make-or-break factor. Without senior leadership endorsement, supervision often becomes inconsistent, undervalued, or cancelled.

2. Supervisor and Supervisee Characteristics

Enablers:

Supervisors who are trained, experienced, and able to build rapport
A sense of mutual respect and trust
Supervisees who are open to reflection and growth

Barriers:

Power imbalances or lack of psychological safety
Supervisors who are overly directive or untrained
Poor interpersonal fit between supervisor and supervisee

The therapeutic quality of the supervisory relationship emerged as central to effectiveness—echoing core principles from psychotherapy itself.

3. Supervision Structure and Process
Enablers:

Clear structure and frequency (e.g., monthly sessions, 60 minutes)
Agreed agendas and goals
A mix of formative (educational), normative (administrative), and restorative (supportive) functions

Barriers:

Sessions that are irregular, unfocused, or too brief
Over-emphasis on administrative tasks (normative function) at the expense of reflection and emotional processing

Supervision worked best when there was a balance between structure and flexibility. Ad hoc or “as-needed” sessions were far less effective than scheduled, prepared engagements.

4. Supervisory Relationship Quality
Enablers:

Trust and safety as foundational conditions
Opportunities for open, non-judgemental reflection
Supervisor modelling vulnerability, reflective practice, and ethical thinking

Barriers:

Defensive or judgemental attitudes
Lack of time for relational connection
Unacknowledged bias or unresolved interpersonal tension

Relational dynamics were shown to be especially influential in mental health and trauma-informed contexts. When trust was absent, supervision could become performative or even damaging.

Key Insights

Effective supervision isn’t simply about frequency or format—it’s about relational safety, organisational support, and supervisor competence.
Supervisors should be trained not just in clinical areas but also in interpersonal, reflective, and ethical dimensions of supervision.
Systems must actively support supervision with policies, resources, and cultural endorsement—it cannot be left to individual goodwill alone.
Supervision should not be reduced to performance monitoring; its restorative and developmental functions must be protected.

Implications for Supervisors and Organisations

This review offers a practical roadmap for enhancing supervision quality. Key recommendations include:

Invest in supervisor training focused on emotional intelligence, feedback skills, and reflective models
Ensure protected time and space for supervision, even during staffing pressures
Foster a culture where supervision is valued and prioritised, not viewed as optional or bureaucratic
Monitor supervision quality through feedback from both supervisors and supervisees

Limitations
The review included a small number of studies (n=16), with some methodological variation. Most studies were from high-income countries and may not reflect global practice. However, the findings align well with existing theoretical frameworks and practitioner experience.