Schwartz Center Rounds to enhance compassionate care: results from a UK mapping survey
Cath Taylor, Senior Lecturer, Florence Nightingale Faculty of Nursing & Midwifery, King’s College, London, and co-applicant on this research, explores and explains these ground-breaking opportunities for dialogue
In November 1994, Boston health care attorney Kenneth Schwartz was diagnosed with lung cancer. During his 10-month illness, he discovered the importance of the human connection between caregiver and patient, saying: “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… The smallest acts of kindness made the unbearable bearable.”
At the end of his life, Ken outlined an organisation he wanted to create: a centre that would promote compassion in medicine, encouraging the sorts of caregiver-patient relationships that made all the difference to him. He founded the Schwartz Centre in 1995, just days before his death. One significant innovation from the Centre has been Schwartz Rounds.
What are Schwartz Rounds?
“(Rounds) provide an opportunity for dialogue that doesn’t happen anywhere else in the hospital”1. They are:
- a regular open forum for all (multidisciplinary) staff
- provide a level playing field to reflect upon, explore and tell stories about the difficult, challenging and rewarding experiences when delivering patient care
- focus on the non-clinical aspects (e.g. psychosocial, emotional, ethical issues)
- provide an environment that is safe and confidential – attendees encouraged to be open and honest and reflect, discuss and explore their experiences
- allow group intervention with multiple perspectives on a theme, scenario or patient case briefly presented by pre-prepared panel
- are opened to the audience for group reflection and discussion, usually facilitated by a senior doctor and psychosocial practitioner
- allow staff to attend as many/few as they wish/are able to. They are not compulsory but are encouraged.
Now, more than 20 years after their inception, an evaluation of Schwartz Rounds in the UK has taken place.
The overall research question was - How does staff participation in Rounds affect staff wellbeing at work, social support for staff and improved relationships between staff and patients including compassion?
The study has taken place:
- over 27 months. Phase 1: Mapping; Phase 2: Case studies
- used mixed methods – questionnaires, interviews, ethnographic observation
- employed Realist Evaluation2 (what works for whom, how, and in what circumstances?).
Phase 1 sought to examine where, when, why and how Rounds had been implemented and inform sampling for Phase 2 case studies.
Schwartz Rounds were first brought to the UK by the Point of Care Foundation3 in 2009 when two sites piloted Rounds. Then, from 2013 to early 2015, there was a sharp increase in adoption of Rounds, coinciding with the publication of an inquiry into failings in care at one UK hospital trust (Mid Staffordshire NHS Foundation Trust), which led to the Francis inquiry: one key recommendation coming out of the Inquiry was the need for “improved support for compassionate caring and committed care and stronger healthcare leadership”. Other reasons for adoption of the Rounds are explored in the BMJ Open publication Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009–2015
What did Phase 1 find about adoption of Rounds?
In England, 116 sites had adopted Rounds as at 15 July 20154. Of these, 60% were in South of England (26% London)
- 44% Acute trusts
- 28% Mental health and learning disability
- 18% Community-only trusts
- 14% (approx.) organisations offering hospice care.
Variability in key aspects
The mapping work compared how Rounds were being run to the recommendations issued by the Point of Care Foundation. Whilst most sites were running Rounds in line with those recommendations, there was much variability in relation to key aspects such as:
- professional backgrounds of facilitators
- availability of administrative support for Rounds
- experimentation with the frequency and timing of Rounds in order to widen accessibility
- attendance of staff – both in terms of wide variation in numbers of attenders and types of staff with particularly notable absence of ward staff.
Summary and next steps
Cath Taylor concluded that: “We can clearly see that Schwartz Rounds may be one way of improving patient care by giving staff support and providing space to reflect and process the emotional impact of their work. There has been a rapid uptake of Rounds in the UK, though this has been variable across type of provider and geographically. However, there are various challenges to implementation and sustainability of Rounds including ensuring accessibility to all staff, and the time and resource required for Rounds.
“Next, we need to know more about how Rounds affect staff wellbeing, social support for staff and relationships between staff and patients. This is the focus of Phase 2 of our work and the findings should be available later this year. Watch this space!”
- Protocol for the evaluation: http://www.nets.nihr.ac.uk/projectsOld/hsdr/130749
The study reported here was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/07/49). The views and opinions expressed therein are those of the researchers and do not necessarily reflect those of the Health Services and Delivery Research Programme, NIHR, NHS or the Department of Health.