Care for the carers, improve care - an introduction to Schwartz Rounds

Schwartz Rounds are a unique forum in which people delivering care can come together and reflect on their experiences. They have a simple aim: to support staff well-being, build empathy and compassion across organisations, and improve the quality of care.

How they work is also quite simple. Meetings are held monthly, usually at lunchtime with some food provided. They are open to all staff – medical, administrative and executive. Sessions are led by a facilitator and clinical lead, and are structured around three short presentations from colleagues reflecting on an experience they have been through in their work. Usually these are connected by a common theme – such as ‘a patient I’ll never forget’, or ‘a good day’ – and they are followed by an open discussion where anyone who wishes to can respond and share their own experiences.

The simplicity of the model belies its effectiveness. Evidence has shown that people who attend Rounds regularly are about half as likely to suffer psychological distress as their non-attending colleagues. For individuals this is clearly good news – and the feedback we receive from people involved in Rounds shows the huge value people place on them.

At a system level, the impacts are harder to measure, but it’s worth reflecting on the statistics on stress and burnout among NHS staff, which make stark reading. There is some variance by job and organisation type, but the NHS’s figures show that staff throughout the system are taking more stress-related absences, reporting higher levels of bullying, and reporting more pressure to come to work when they aren’t well. Many staff are voting with their feet and leaving the service altogether: recently we have seen a net reduction in nurses and midwives, for example, and many health organisations are struggling to recruit and retain staff. The NHS has been running a campaign, ‘We are the NHS’, to try to attract qualified people back into the thousands of unfilled vacancies in the NHS. Properly taking care of staff has to be part of the solution to this national problem.

There is a connection between positive outcomes for staff and improved care. This link has been at the heart of the Schwartz model since it was first developed by the Boston-based Schwartz Center for Compassionate Healthcare, in the 1990s. Kenneth Schwartz, the organisation’s founder, died in 1995 from lung cancer. Through his illness he had written movingly of the way that healthcare professionals, while unable to cure his disease, made the unbearable bearable by showing small human touches towards him. The Schwartz Center developed Rounds as a way to support healthcare staff to deliver that human care, recognising that compassion, while a natural human quality, is not always easy to deliver within a process-driven system.

So Schwartz Rounds are about more than just looking after staff (important thought that is). At their root is the objective of supporting better care for patients.

To bring the story up to date, Rounds were introduced to the UK in 2009 by the Point of Care Foundation, which provides training for facilitators and supports the process of establishing Rounds at organisations. They are now in regular use at about 200 health organisations (largely hospital trusts, GP surgeries and hospices) in the UK and Ireland.

Based on what we have seen of their impact, we believe Rounds can offer benefits to people beyond the healthcare sector. Many of the challenges we find in the NHS – staff struggling to give their best in a difficult system, undertaking work that has huge emotional impact but perhaps without the space to reflect and process the affect the work is having on them – are just as prevalent in other services. And the need to support compassionate care is not limited to health services. We believe that taking this model and applying what we have learned in healthcare to children’s services could be good for staff and ultimately benefit young people.

For this reason we are excited to be joining the What Works conference to talk about Schwartz Rounds with the children’s services sector. We are looking to recruit sites to pilot Schwartz Rounds in children’s social care organisations. We think Rounds could have great impact for individuals and organisations in social care, and the pilots will enable the What Works Centre to evaluate this.

How to apply for funding support.

Deadline: applications should be emailed to wwccsc@nesta.org.uk by noon 18 February 2019.
To talk with us about your application, please contact CASCADE, Cardiff:
Telephone: 02922 510 943, Email:
wwc-cascade@cardiff.ac.uk