Being human is being professional is being a doctor: how Schwartz Rounds can improve practice

Aggie Rice, Schwartz programme manager, Point of Care Foundation and Jocelyn Cornwell, chief executive, Point of Care Foundation

 

At this year’s RCP’s annual conference, Innovation in Medicine 2018, the Point of Care Foundation and the RCP’s Our Future Health (https://www.rcplondon.ac.uk/our-future-health) policy team staged an event entitled ‘From surviving to thriving: culture in healthcare’ – an interactive session exploring how Schwartz Rounds can improve the culture in healthcare.

‘What does it mean to be a professional?’ This was the theme that emerged
from the session, attended by 100 physicians, which then culminated in a demonstration Schwartz Round.

Over the course of an hour, having established the ground rules, delegates heard from three panel members: Professor Dame Jane Dacre, Professor Namita Kumar and Dr Mike Gill. Each panel member told a short story about something of personal significance from their working lives. The discussion opened up to include the audience who commented, reflected and shared their own stories.

Here is a flavour of two stories told that morning (some details have been changed to protect identities, and consent was obtained from the participants):

I was a senior registrar in A&E when a young man was admitted after a catastrophic subarachnoid haemorrhage. His wife and children were with him. At the moment when the consultant told the wife that we could not save her husband, I noticed that everyone in the room, other than me, the woman and the consultant was crying. At the time I thought that was unprofessional but have since wondered “Is it me who lacks normal feelings?”

A patient I have known well for many years complained of stiffness and pain in his neck but protested so vigorously when I suggested an MRI that I delayed the referral. The next time I saw him, he was paralysed from the neck down. I had left the referral too late and now feel guilty every time I see him. He insists it was the surgeon’s fault, not mine

The issues raised in the discussion were about what being a professional means: Is it okay to be human? Is it wrong to show we have feelings too? How does it affect our patients? ‘Being human is being professional is being a doctor’, commented one audience member. Others disagreed, but the objective wasn’t to find consensus. The demonstration Schwartz Round provided the forum within which to share experiences, reflections and emotions – a process we know significantly enhances psychological wellbeing and quality of care.

Schwartz Rounds were developed in the USA by the Schwartz Center for Compassionate Healthcare in the 1990s to provide a safe psychological space for all staff to reflect together on the non-clinical aspects of work with patients. There is now a solid body of evidence which shows that the Rounds are good for the people who attend them. For participants, the process of sharing and reflecting on experiences results in feeling more empathy for patients, less isolated and better able to communicate with colleagues. Crucially, evidence shows people who attend Rounds to be less stressed and psychologically healthier than their non- attending colleagues. (https://www.pointofcarefoundation.org.uk/evidence/realist-informed-mixed-methods-evaluation-schwartz-rounds-england/)

At Innovation in Medicine, the demonstration Round was like a normal round in some – but not all – aspects. It had the same format, and the same qualities of openness, intense listening and occasional silences. But the panellists and audience were all doctors and this was a one-off, whereas in organisations, normal rounds are multidisciplinary and happen every month.

In the UK and Ireland, The Point of Care Foundation (POCF), a London-based charity, holds a licence from the Schwartz Center to promote and spread the Rounds. The Point
of Care Foundation has helped more than 190 organisations establish the light touch infrastructure they need to run Schwartz Rounds monthly, and train facilitators and clinical leads from the host organisation in the skills required to make the Rounds a safe psychological space where people can talk to one another as equals about matters that are often not discussed.

‘Schwartz Rounds are part of our mission to humanise healthcare’ says Point of
Care Foundation’s chief executive Jocelyn Cornwell. ‘We want patients everywhere to be treated with kindness and compassion all of the time; and to achieve that we believe that support for staff is essential. Sharing and reflecting on experiences through Schwartz Rounds provides a means for supporting all healthcare staff to cope better with the emotional and psychological challenges of their roles.’

Schwartz Rounds Q&A

What do Schwartz Rounds look like?

Schwartz Rounds follow a standard model that is replicated across different settings. They take place once a month, for an hour at a time, most often at lunch with food provided. Three panellists from different disciplines present 5-minute stories of their experiences of working in healthcare. The stories may be based on a particular theme, such as ‘a patient I will never forget’ or ‘being

thrown in at the deep end’, or a specific case. A trained facilitator and clinical lead open the conversation out to the audience, guiding the discussion and drawing out themes. Schwartz Rounds are purely reflective and the intention is that outcomes or solutions are not discussed.

How are Schwartz Rounds different from other forms of reflection and supervision? Schwartz Rounds are not designed as a form of supervision and do not fit the traditional model of clinical supervision: there is no expert and no advice given, large groups of clinical and non-clinical staff attend, they do not focus on procedural or technical aspects of care, clinical outcomes or personal development, and they don’t happen in response to an adverse event. However, Rounds share some similarities to supervision in what they can offer: alleviating anxiety, supporting personal development through listening and sharing experiences with others, and helping people to feel more supported in their role.

Can patients attend Schwartz Rounds?

No. Schwartz Rounds exist to provide a space for staff to come together regularly to discuss the emotional and social aspects of working in healthcare. This could be discomforting if patients are present.

How can ward staff access Rounds?

Rounds often start within an organisation as a lunchtime meeting. To enable more staff
to access them, we recommend that some Rounds are held at breakfast, afternoon tea, or evening before the start of night shifts.

We have also developed, in collaboration with Ashford and St Peters NHS Trust, training for running ‘pop-up Rounds’ to enable shorter Rounds on wards.

Are Rounds CPD accredited?

Schwartz Rounds have been accredited by CPD-UK. It is up to individual learners to identify the learning benefit, number of points and type of CPD activity (eg reflective practice).

How many people are needed to run Schwartz Rounds?
Schwartz teams consist of a steering group, clinical lead, one or two facilitators and the Schwartz administrator. Rounds have no formal limits on audience size, and it will depend on the size of your organisation and available settings, but generally a minimum of ten participants are needed in addition to the panel and discussion leaders.

How do I get Rounds set up in my organisation?
To operate Rounds, organisations require a license from the Point of Care Foundation, which provides training and support for Schwartz Rounds in the UK and Ireland.

Rounds are a long-term commitment and require top-level support before we can enter into contract. Organisations need to prioritise resources to set them up and sustain them, and to encourage and enable attendance. We have tools to support individuals making a business case for Rounds within their organisation.

What do we get for our investment?

The initial 2-year contract for training and support covers: the licence to run Rounds; training for three clinical leads or facilitators; three days of individual support from a mentor; two annual conference places; access to Schwartz Community webinars and resources; and ongoing support from The Point of Care Foundation Schwartz Team.

What are the cost benefits to running Schwartz Rounds?
It is estimated that the median cost of sickness absence to each NHS organisation is £3.3 million annually. Improving staff wellbeing reduces sickness and absence, the use of bank agency staff and the costs associated with recruitment and induction.(http://webarchive.nationalarchives.gov.uk/20130124052413/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108910.pdf) Organisations known to be committed to improving staff experience are better able to recruit and retain staff, saving money
and improving productivity (https://www.mind.org.uk/media/43719/EMPLOYERS_guide.pdf)  Dawson (https://www.england.nhs.uk/wp-content/uploads/2018/02/links-between-nhs-staff-experience-and-patient-satisfaction-1.pdf) shows how patient satisfaction is higher in organisations which score more highly for staff engagement. Staff attending Schwartz Rounds report increased confidence in communicating with patients – the impact of which may help reduce complaints from patients and families.

 

Aggie Rice, Schwartz programme manager, Point of Care Foundation and Jocelyn Cornwell, chief executive, Point of Care Foundation

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