Take staff support seriously with Schwartz rounds

Volunteers for the Samaritans telephone line deal with callers who are very distressed, and so in their downtime between calls they are encouraged to share their last call with their volunteer partner.

‘There is often little support or any opportunity for staff to share their experiences or debrief with colleagues’

This, together with debrief sessions at the end of the shift, signifies the importance the organisation places on the emotional and psychological support of volunteers. They recognise the importance of caring for the care giver.

Staff who work in the NHS also deal with people who are distressed, yet there is often little support or indeed, any opportunity for staff to share their experiences or debrief with colleagues.

Many opportunities that previously existed have been eroded in a fast paced, target driven working environment with shortages of staff.

Compassion burnt out

NHS workers care for people when they are often at their lowest point, when newly diagnosed, chronically sick or when trying to make sense of the reckless indifference of their disease.

Really relating to patients, connecting with them and sharing their distress takes courage and requires support to prevent staff burning out, losing their empathy and erosion of compassion.

‘The rounds are said to provide a safe space for staff to talk about the difficult, and motivating, aspects of their work’

The King’s Fund’s Point of Care programme first brought Schwartz rounds to the UK in 2009, and in 2013 the Point of Care Foundation became an independent charity dedicated to improving patients’ experiences of care and increasing support for staff who work with them.

The rounds are said to provide a safe space for staff to talk about the difficult, and motivating, aspects of their work: their distress, conflict, guilt and the memories of past patients that cause them to “wake up in cold sweat in the middle of the night”.

Care in the round

The system was developed by the Boston based Schwartz Center for Compassionate Healthcare following the death of Ken Schwartz in 1995 from lung cancer.

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During his treatment, Mr Schwartz noted how some healthcare staff were able to be compassionate while others were not, and how the same person could be compassionate one day and not the next.

Before his death he set up the Schwartz Center as a not for profit organisation designed to nurture compassion in healthcare, to encourage healthcare workers to make “the unbearable bearable” through “the smallest acts of kindness”, and to strengthen the relationship between patients and their clinical care givers. The rounds were set up in his memory as a space for staff to talk about their feelings and emotional responses their work evokes.

‘In contrast to traditional medical rounds, the focus is on the human dimension of medicine’

They are are multidisciplinary meetings where clinical and non-clinical staff from across the hospital voluntarily come together to discuss the psychological, emotional and social challenges associated with their jobs. They typically take place once a month for an hour and offer healthcare workers a regularly scheduled time to openly and honestly discuss the social and emotional issues they face in caring for patients and families in a safe and confidential environment.

In contrast to traditional medical rounds, the focus is on the human dimension of medicine.

Each round begins with a panel presentation of an anonymised patient case by the team that cared for the patient. The panel describes the impact the case had on them and a trained facilitator guides the ensuing discussion, allowing the audience to reflect with the panel on similar experiences that they have had.

Impact of Francis

Schwartz rounds were identified by Robert Francis in his report last year as an intervention to bring staff together and with a positive impact on staff and on compassionate care.

Rounds are currently running in 300 healthcare organisations in the US and are being implemented in over 60 in the UK, with acute hospitals, hospices, mental and community health trusts in the mix.

Evaluations in the US and from the UK pilot sites show positive benefits. Attendees reported that rounds enhanced their likelihood of attending to psychosocial and emotional aspects of care, better teamwork and a decrease in stress.

‘The uptake and spread of Schwartz rounds in the UK is perhaps a sign that the NHS is taking staff support seriously’

The rounds were said to be restorative; to allow staff to constructively process difficult patient care experiences, and to gain reassurance, support and new ways of coping. They were said to “provide an opportunity for dialogue that doesn’t happen anywhere else in the hospital”.

Rounds are expanding rapidly in the UK, and there is now a need for a national evaluation to understand whether and how they confer benefit. The National Institute for Health Research has commissioned research evaluating rounds to start in September.

The uptake and spread of Schwartz rounds in the UK is perhaps a sign that the NHS is taking staff support as seriously as the Samaritans.

Professor Jill Maben is director of the national nursing research unit at the Florence Nightingale School of Nursing and Midwifery, King’s College London