On several occasions, Physiotherapy Alberta members have asked if they could supervise their spouse, a close relative, or friend as a physiotherapy intern or while doing a restricted activity before becoming authorized. Physiotherapy Alberta strongly advises against these supervision arrangements because of the potential risk for a conflict of interest.
First, what is supervision?
The Cambridge dictionary defines supervision as “the act of watching a person or activity and making certain that everything is done correctly, safely, etc.”1 I like this definition as it applies to the supervision relationships common in physiotherapy. The 2017 Competency Profile for Physiotherapists in Canada2 identifies supervision as an essential, entry-level competency. The competency includes the roles of assessing the competence of the supervisee, assigning and monitoring care delivery, being involved in training, and providing guidance and feedback to those under supervision. In other words, the supervisor is responsible for ensuring assigned physiotherapy services are provided safely and effectively, by competent individuals.
There are several supervision relationships encountered in physiotherapy practice: the supervision of a student, the supervision of a support worker, the supervision of a physiotherapy intern on the provisional register, and the supervision of a colleague performing a restricted activity before they are authorized. Each of these scenarios has unique circumstances to consider but they all have one thing in common: the supervisee is performing duties or acts that require someone to supervise their actions and ultimately ensure safe, high-quality and effective patient care.
The Supervision Standard states, “the physiotherapist is responsible and accountable for the physiotherapy services provided by personnel working under her/his supervision.”3 This Standard identifies the responsibilities of supervisors when they accept the role and agree to supervise another individual providing physiotherapy services.
The Supervision Standard3 lays out the expectations of the supervising physiotherapist. Inherent in this Standard are the expectations that the supervisor:
Assesses the knowledge and skills of supervisees.
Assigns only those tasks/activities that fall within the supervisee’s competence.
Assigns only those tasks/activities that the supervisor is competent to perform.
Monitors and evaluates the delivery of services by supervisees.
As a supervisor you must be willing and able to intervene and/or reassign duties if the supervisee demonstrates he/she does not have the required competence to safely provide the assigned care. The Supervision Guide4 provides further information to members to guide the supervision relationship and support the supervisor. The guide offers suggestions about how to go about meeting the requirements outlined in the Standard.
Although Physiotherapy Alberta only requires the submission of formal, signed supervision agreements when the supervision relationship involves a physiotherapy intern,5 the agreement clearly identifies Physiotherapy Alberta’s expectations of both supervisors and supervisees. These expectations are relevant for all supervision relationships.
I suggest you conduct a thorough review of all three documents before agreeing to enter into a supervision relationship.
The Conflict of Interest Standard addresses the responsibility of members to identify and manage relationships that may interfere with a therapist’s ability to deliver services without compromising professional judgement or patient care.6 It is expected that the supervisor:
Identifies and manages any situations of real, potential, or perceived conflicts of interest involving themselves or a related person.
Refrains from participating in any activity in which professional judgment could be compromised or is for personal gain.
In situations where conflict of interest cannot be avoided, manages and provides full disclosure of the conflict of interest to clients and others as appropriate and documents in a complete, open, and timely manner how the conflict was managed.
Why should I be concerned about conflict of interest?
In situations where you and the supervisee are related, or have a close personal relationship, other factors must be considered to avoid potential or perceived conflicts of interest or challenges in meeting the expectations of being a supervisor.
As a supervisor, you must be able to objectively evaluate the supervisee’s knowledge, skills and care delivery. You must give constructive, unbiased advice and guidance and, most importantly, limit or restrict practice when appropriate. Although the supervisee is accountable for the services they provide, the role of a supervisor is to ensure that client care is safe, of high quality and effective.
The challenge, then is to separate the personal relationship from the supervision relationship. Both supervisor and supervisee must recognize that this relationship will be different from their personal one. There may a different power balance inherent in the roles of the supervisor-supervisee relationship that must be understood and accepted.
Imagine a situation where you are supervising your spouse and become aware of an area of weakness in practice that puts patient care at risk. In a regular supervisor/supervisee relationship, your decision to provide increased monitoring or to restrict the supervisee’s practice would be relatively clear. However, if a spouse is involved, the decision could be influenced by the personal relationship, making it more difficult for you as the supervisor to restrict practice or to provide feedback and direction to correct the problem. The spouse being supervised may also find it very challenging to accept criticism or direction from you, the supervisor.
There may also be financial implications if both individuals work within a setting in which incomes are based on numbers of patients treated each day. It could be tempting for you to overlook practice issues and allow your spouse to continue to see patients under an indirect supervision model. If these decisions are influenced by financial interests a real conflict of interest exists. If one of you is the clinic owner/manager, these lines become even less clear and the risk is greater.
What does Physiotherapy Alberta advise?
It is Physiotherapy Alberta’s expectation that members “Refrain from participating in any real, potential, or perceived conflicts of interest.”6 If there are no other supervision options, and the supervisor and supervisee have established measures to manage the conflict of interest there may be instances where this supervision arrangement may be acceptable (for example, in a remote rural setting). If this is the case, there is the expectation that members “Disclose any activity or arrangement that constitutes a conflict of interest for themselves or a related person to the Registrar.”6
After careful review of the relevant Standards and resources and an objective, honest discussion with the supervisee, you must feel comfortable and confident that you can assume the supervisory role, fulfill the Standards of Practice and manage any potential conflict of interest. If this is the case, an agreement to enter a supervision arrangement may be appropriate. Both the supervisor-supervisee must continue to monitor the situation and withdraw from the relationship if it becomes apparent it is no longer possible to honestly separate the personal from the supervision roles.
Cambridge Dictionary - Supervision: Available at https://dictionary.cambridge.org/dictionary/english/supervision Accessed Feb. 6, 2018
2017 Competency Profiles for Physiotherapists in Canada. Available at https://www.physiotherapyalberta.ca/files/competency_profile_2017.pdf Accessed Feb 6, 2018
Physiotherapy Alberta – College + Association. Standard of Practice - Supervision. Available at https://www.physiotherapyalberta.ca/files/practice_standard_supervision.pdf. Accessed on February 6, 2018
Physiotherapy Alberta – College + Association. Supervision Resource Guide for Physical Therapists, 2008. Available at https://www.physiotherapyalberta.ca/files/guide_supervision.pdf. Accessed on February 6, 2018
Physiotherapy Alberta – College + Association. Supervision Agreement. Available at https://www.physiotherapyalberta.ca/files/supervision_agreement.pdf Accessed February 8, 2018.
Physiotherapy Alberta – College + Association. Standard of Practice – Conflict of Interest. Available at https://www.physiotherapyalberta.ca/files/practice_standard_conflict_of_interest.pdf. Accessed on February 6, 2018.
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Practicing as a Physiotherapist in Alberta
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.