Table 3 Summary of reviewed studies
From: Micromanagement in clinical supervision: a scoping review
Topics | |
|---|---|
Concepts | Excessive Control [2, 6, 18, 22, 26] - exercising tight/excessive control over trainees - sense of need to control everything Scrutinizing [2, 6, 18, 22, 23] - unnecessary attention to every last detail - closely monitoring the minutiae of work practices Domination/Oppression [18, 20,21,22,23] - full domination; being autocratic; forcing conformism - cannot work through others; not allowing trainees to make autonomous decisions Ineffectual Leadership [20] - being autocratic; emphasizing conformity rather than organizational learning |
Potential Counter-balancing Concepts | Autonomy/Entrustment [2, 6, 18,19,20,21,22, 24, 26] - granting trainee’s an appropriate level of autonomy; - being aware of what micromanagement brings - entrusting trainees to care for patients autonomously; Entrustable professional activities - promoting trainee engagement/trainee’s sense of responsibility for patients Effective Supervision [18, 19, 24] - appropriate/consistent/effective supervision Effective Leadership/Leading [2, 19, 20, 22] - having a team of specialists work; working through others Educational Mind/Scaffolding [6, 18,19,20, 24, 26] - promoting trainee’s independent practice and organizational learning; - developing learners’ progress towards the ultimate goal of independent practice; - trainees to actively hone their own skills - individual coaching; mentoring; scaffolding |
Reasons/ Affecting Factors | FACULTY FACTORS BEHAVIORAL AND PERSONALITY FACTORS Distrust [2, 6, 17, 18, 23, 26] - trouble trusting others; extreme irritation when trainees make even the smallest of decisions without first consulting them; believing that only they can do the job correctly; ownership of patients; lower threshold to intervene with trainees - personal insecurities Perfectionism [2, 6, 22, 23, 26] - need to be perfect in the eyes of others; pressures to meet key performance indicators; obsessive high-achiever personality - fear of failure; avoidance of errors; risk aversion; nervousness about either overall practice level or trainee’s performance; - being more professionally confident; judging themselves superior - arrogance and grandiosity - strive to overachieve to demonstrate their worth - self-doubt; lack of confidence with their own skills LEADERSHIP AND MANAGEMENT FACTORS Backseat Driving [19] - not leaving work area, imposing personal management style Failing to Yield [19] - predetermining course of action; changing plans without alerting trainees Lack of Leadership Experience and Training [2, 17, 22, 23] - recently moved into the ranks of leadership from a prior non-supervisory position; inexperience - no leadership training UNBALANCED SENSE ABOUT FACULTY RESPONSIBILITIES Unbalanced Commitment to Patient Care and Clinical Education [26] - putting undue weight on clinical care and responsibility - disregarding educational responsibility |
TRAINEE FACTORS Lack of Efficiency/Competency [26] - the year (level) of training; clinical experiences - trainee’s performance in terms of effectiveness and efficiency Lack of Apparent Confidence [26] - lack of authenticity in self-confidence; preconceived view of the trainee Lack of Autonomous Behavior [26] - lack of self-determination and autonomous behavior | |
ENVIRONMENTAL FACTORS PATIENT CARE CONTEXTUAL FACTORS Volume/Severity/Complexity of Patient Care [21, 25, 26] - patient volume (how busy was department); - the acuity/severity of the patient; - high complexity/uncertainty of problem or task; - socio-medical issues of patient/family Nursing Capability [26] - number, skills or experience of the nursing staffs - some case requiring faculty presence or higher precision ORGANIZATIONAL CULTURE FACTORS Organizational Culture Perpetuating Micromanagement [2, 24, 26] - culture of high performance; measuring quality metrics; - culture of close supervision; - tight regulations of duty hours | |
Consequences | Professional Development Perspective CONSEQUENCES FOR TRAINEE Negative Influences on Learning Environment [6, 21, 24] - loss of educational development and self-confidence; preventing trainees from fully developing their own clinical skills; restricting trainee autonomy and competence; - loss of enthusiasm and creativity; generating a sense of trainee’s apathy Negative Influences on Trainee’s Wellbeing [6, 21, 24] - trainee fatigue/burnout; - trainees’ increased resentment and cynicism; - threatening trainees’ psychological, emotional and cognitive safety; - poor health outcomes of trainees |
CONSEQUENCES FOR FACULTY Damage to Personal Reputation of supervisor [2] | |
Patient Service Perspective CONSEQUENCES FOR PATIENT CARE Threat of Safety and Quality of Patient Care [22, 23] - threatening safe patient care; - ineffective patient care; - undermining practice capacity to serve patients | |
Organizational Development Perspective CONSEQUENCES FOR ORGANIZATION Organizational Dysfunction [6, 22, 23, 26] - high staff turnover; decreased job satisfaction; - absenteeism; being laissez faire; - stifling team-members’ enthusiasm and creativity; - preventing team members from contributing to discussions, making initiatives, and being engaged - debilitating team- - demoralizing team - harming relationship among trainees; bickering among each other - lack of unity within teams; lack of goodwill | |
Solutions | Professional Development Perspective FACULTU SIDE SOLUTIONS FOR FACULTY BEHAVIORAL AND PERSONALITY FACTORS Self-awareness [2, 22, 23, 25] - recognizing the tendency of micromanagement and admitting that it is natural; assessing faculty their own ability to work through others effectively; studying the triggers for micromanagement; delineating between support and micromanaging and identifying when to rectify incongruence; planning for gradual improvement Solutions for Faculty Leadership and management factors Entrust/Empowerment [19, 21,22,23, 25] - delegating everything possible; challenging trainees to think and act independently; promoting their decision making; encouraging their patient ownership; - ‘roadside assistance’; back-stage approach to clinical oversight; serving as safety net; - spreading the work load; sharing reward; enjoying success together; learning the power of a team; - development of trust (truthfulness and benevolence) Encouraging and Clear Communication [2, 19] - promoting constructive communication styles, e.g., praising abilities; clear communication regarding roles and responsibility - faculty development or enhancing effective supervisory strategies in clinical care |
Professional Development Perspective TRAINEE SIDE SOLUTIONS FOR TRAINEE COMPETENCY AND CONFIDENCE FACTORS Training [21] - competency-based education; trainees’ milestone in professional development - trainee education on the importance of seeking supervision in clinical care and recognizing the liability inherent in the clinical decision-making process SOLUTIONS FOR TRAINEE AUTONOMY FACTORS Open Communication [2, 17, 20] - open the conversation by focusing trainee’s optimal contribution; asking for feedback and areas for improvement to identify supervisor’s concern; gently describing the impact of micromanagement; team members being open in their support of team goals and priorities | |
Organizational Development Perspective ENVIRONMENT SIDE ORGANIZATIONAL INTERVENTION Organizational Management [2, 19, 24] - reducing work load pressure on ‘attendings’; - being sensitive to team dynamics and hierarchy; - providing support systems and ongoing assistance for supervisors and trainees; - redefining and evaluation of quality supervision Balanced Valuing of Clinical and Educational Goals [19] - modernizing the organizations to achieve two equally important goals of improving the quality of care and enhancing residents’ education - organizational training on mentoring, coaching, autonomy and trust building | |