Supervision practices in an English National Health Service organisation
: complexity and paradox

  • Denise Harris

Student thesis: Doctoral Thesis


Staff employed in health and social care organisations are expected to participate in supervision practices which mean regular and protected time for discussion, reflection, and feedback on their work. Despite an extensive literature base, research has shown that implementing successful processes to support these practices remains challenging. To date, much of the literature has focused on specific functions such as training or supervision processes, and employed solutions designed to ‘fix’ the challenges. There remains little that has explored an organisation-wide perspective. This study builds on current research and contributes to the understanding of the nature of supervision practices. It provides additional insights to inform organisational approaches to supervision in an English National Health Service (NHS) organisation (the Trust). The study aimed to investigate how supervision across all staff groups, and at all levels in the organisation, could be enhanced.

Following a social constructionist and ethnographically informed research approach that drew on focused ethnography, data was gathered over 18 months, through four focus group, and five one-to-one interviews, with staff with a cross-section of roles and levels of seniority.

Combining thematic analysis and complexity theory revealed supervision practices to be a complex adaptive system, underpinned by discourses of order and paradox. This study contributes to knowledge in the understanding of the relationship between supervision practices and organisational culture by adopting an organisation-wide perspective of supervision.

The dominant discourse of order, and ‘fixing’, that permeates organisational processes, means ‘paradox’ is rarely acknowledged other than as a barrier to the desired order. This study problematises the concept of supervision practices as fixed and definable, and instead presents them as complex, emergent, and subject to context and system history. It reframes paradox as a critical element of supervision practices, which generates energy, and contributes to the positive impact of those practices on individuals and organisational priorities.

This alternative understanding has significant implications for a revised approach to supervision practices. The principal recommendation is an organisational narrative which acknowledges and embraces supervision practices as complex and paradoxical, enabling a flexible and dynamic approach and allowing for improvisation, creativity, and innovation.

Re-imagining supervision practices in this way, also contributes to the application of complexity thinking in the realm of organisational research and has implications for this beyond supervision practices.
Date of AwardFeb 2022
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorAlec Grant (Supervisor), Jane Morris (Supervisor), Kay Aranda (Supervisor) & David Haines (Supervisor)

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