Schwartz Rounds – what are they and how do they support all staff groups working in healthcare?

We interviewed Rhiannon Barker, Head of Program Development, Point of Care Foundation, about how the Schwartz model can benefit supervision practice in a range of interprofessional healthcare settings.

Rhiannon Barker

Working in the healthcare sector is a highly rewarding profession. You are ultimately saving people’s lives every day. However, the course of life, illness and accidents cannot always be saved by medical intervention and the pressure of this can leave you emotionally drained.

Enter the Schwartz Rounds: reflective monthly meetings where multiprofessional groups of staff from healthcare organisations come together to explore the emotional aspects of working in healthcare. The Schwartz Rounds concept was developed 15 years ago at the Schwartz Centre for Compassionate Healthcare in Boston, USA. 


What do Schwartz Rounds look like in practice?

Schwartz Rounds follow a standard model determining how they should be run, ensuring that they can be replicated across different settings. A panel of three or four staff members from different disciplines present stories of personal experiences – focusing specifically on emotional issues arising during the course of work. Two trained facilitators then open the discussion out to the audience. The facilitators guide the discussion, keeping it a reflective forum and drawing out themes from the audience’s contributions.   

The full circle of compassion and kindness

Schwartz Rounds are purely reflective, and the intention is that outcomes or solutions are not discussed. In healthcare, there is both individual and organisational pressure to identify solutions, so reflecting without solutions can feel new and perhaps uncomfortable. The practice was developed following the death of Kenneth Schwartz in 1994. Kenneth, a young health lawyer from Boston was diagnosed with lung cancer. Before he died, he wrote a story about his care, in which he described the distress of the diagnosis and range of treatments he had to endure. But amongst the distress, Ken experienced moments of compassion and kindness from healthcare staff, which he highlighted as a vital part of care. He said:

‘I have learned that medicine is not merely about performing tests or surgeries, or administering drugs…for as skilled and knowledgeable as my caregivers are, what matters most is that they have empathized with me in a way that gives me hope and makes me feel like a human being, not just an illness.’
(Schwartz, 1995)

Showing great insight into the strong interconnections between the state of mind of the staff and the way that impacts on patient care, Schwartz recognised that by offering more robust support to staff they would be better placed to offer more compassionate care to the patients they treated. From this understanding Schwartz Rounds were born. In 2009, Schwartz Rounds were brought to the UK by the Point of Care programme at The King’s Fund and continue to be implemented by The Point of Care Foundation. In March 2014, over 130 healthcare organisations in the UK were signed up to run Rounds.

The need for support amongst healthcare staff

Last year, according to the NHS Staff Survey, nearly 40% of staff reported feeling unwell as a result of stress. The Care Quality Commission says that poor staff health and well-being in NHS provider organisations is associated with poorer quality patient care, lower levels of patient satisfaction and high levels of absenteeism. One of the five key requirements of a Care Quality Commission inspection is to assess whether ‘staff involve and treat people with compassion, kindness, dignity and respect’ – and evidence from the Rounds suggests that staff who have attended Rounds feel better able to treat patients with more compassion and empathy. 

Staff who attend Rounds regularly have been shown to feel less stressed and isolated, and report improved teamwork. NHS England recognise that engaged and supported staff provide high quality care and to support this recommend the introduction of Schwartz Rounds in its 2014/15 – 2016/17 business plan Putting Patients First.

Organisations interested in implementing Rounds require a motivated team of core staff, funding for training and support from The Point of Care Foundation, and top level commitment from the organisation to ensure that food is provided to feed staff (usually lunch eaten before the Round) and that staff are encouraged and enabled to attend.

Following each Round staff are asked to routinely complete feedback forms. Data analysed from over 9,000 forms collected from 46 organisations between 2013-15, shows that 87% of those attending agree, or strongly agree, that the Rounds help them to work better with colleagues. Staff also feel that Rounds provide insight that will help them care for patients (83% agree or strongly agree). 94% agree that they intend to attend Rounds again.


How can you embed the Schwartz Rounds into your organisation?

Working to embed the Rounds in an organisation so that they become an accepted part of staff support is not for the faint hearted! Hard work, commitment and a deep seated belief that staff deserve and benefit from this type of reflective practice – is a necessary prerequisite. But once Rounds begin to be an understood and accepted part of the culture, appreciation of their value is generally forthcoming. Comments made by Round attendees demonstrate a variety of reactions: normalising emotions, promoting connectedness, role modelling and creating a culture of openness. 

‘I sometimes feel as if you’re a little part of a jigsaw and going to a Schwartz Round you see all the other bits of the jigsaw, so you actually get the whole picture which is [...] it’s reassuring, it’s comforting, it’s enlightening, it’s educational, it’s all these things.’
(Volunteer at Round)

‘I’ve been interested listening to the various contributions how many of my own emotions it’s unlocked. Emotions that were deeply buried within me. I think we all tend to do this and the danger of locking things away is that you then don’t recognise these feelings when other people are going through them.’ (Consultant at hospital Round)

‘…that surgeon is so high up I would normally be intimidated by him. I’m a medical student…. his presentation made him so much more approachable. So if I now had him {for a teacher} and you find a situation upsetting you would be much more likely to say something or be more open with him. Not to be so scared to say something … it’s good bridging.’ (Medical student attending a Round)

Rhiannon Barker and Dr Esther Flanagan will be presenting a workshop about Schwartz Rounds at the one-day CPD accredited training conference Enhancing Staff Supervision in Health and Adult Social Care: An interprofessional approach on the 14 June 2016 in ORT House, London. Book your place here.

They also co-wrote a chapter about Schwartz Rounds in The Pavilion Annual: Interprofessional Staff Supervision in Adult Health and Social Care Services.

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