Schwartz Rounds could help improve staff well-being and patient experience

Dr Sara McNally, Consultant Liaison Psychiatrist and Schwartz Rounds Steering Group Chair at the RNOH, talks to us here about how the Rounds work and the potential benefits for staff and patients.

What are Schwartz Rounds?

Schwartz Rounds are a multidisciplinary forum held once a month for staff to discuss a particularly complex patient case which has posed challenges – not in a clinical sense but in terms of the emotional or social issues around it. They provide an opportunity for individuals to discuss their experiences of a case in a supportive and confidential environment.

The Rounds are a legacy of Ken Schwartz, a Boston healthcare lawyer who, in 1994, was diagnosed with advanced lung cancer at the age of 40. Ken said it was “the smallest acts of kindness” between patients and caregivers that made the “unbearable bearable” during his treatment. In 1995, he founded the Schwartz Center organization just a few days prior to his death – and so the Schwartz Rounds began 20 years ago at Massachusetts General Hospital.

The King’s Fund and Point of Care Foundation piloted the Rounds at two UK hospitals several years ago. Since then, they’ve gone from strength to strength such that now about 90 NHS trusts use them in the UK; predominantly acute trusts, hospices and a few mental health trusts.

How do they work?

Rounds are open to any member of staff – clinical or non-clinical, and staff of all levels are encouraged to attend. Everybody going into the round signs a confidentiality agreement at the door that the discussion remains within that room and the identity of the patient is anonymous.

Two or three key members of staff who have been involved with the patient have five to ten minutes each to present the case from their perspective, after which it is open to the floor for people to ask questions. It’s not about problem solving nor should it be judgmental; it’s about staff being given the opportunity to ventilate how they felt caring for that particular patient. Rounds can also help give staff a sense of closure in difficult cases.

What are the benefits?

The NHS, with its financial pressures, efficiency targets and increasing number of administrative demands on staff can lead to too narrow a focus on solely diagnosis, management and clinical outcomes with less time spent with patients – which can threaten the delivery of holistic and compassionate care. It’s well-known that if staff don’t feel valued or supported, over time there is a risk of burnout and loss of ability to empathise with your patients. Empathy is all about being able to step into that person’s shoes and if you’re burnt out and have nothing left to give emotionally to your job then you run the risk of becoming an automaton.

Schwartz Rounds can help to counter this. Research shows that individuals involved in Rounds feel more valued for the difficult job they do, with the consequence of being able to deliver more empathic care; which in turn has a positive impact on patient experience. There is also evidence that the Rounds improve communication and team working more generally, and on a wider scale that has a positive impact on the culture of the organisation as a whole. 

Schwartz Rounds at the RNOH

The RNOH is a specialist hospital, which means that cases are complex from an orthopaedic perspective. However, this complexity is not just isolated to the patient’s skeleton – as a consequence of the orthopaedic problem our patients are quite often complicated from a social and psychological perspective too.

I think the Rounds will be a success at the RNOH. Despite the fact individual staff members may have been looking after the same patient for many months, they might not always have an opportunity to share their experiences. By providing this opportunity, I hope the Rounds will encourage more openness between staff and support a greater appreciation of, and respect for, the work that colleagues do in different disciplines and departments.

We held our first Schwartz Rounds Steering Group meeting at the RNOH in September, and we’re extremely fortunate to have three Board members in the Group who are enthusiastic and supportive of the Rounds: Lucy Davies, new Chief Operating Officer who worked at Harefield and so has seen the Rounds there in action: Mat Shaw, Medical Director who has witnessed Rounds in Boston, and Paul Fish, Director of Nursing at the RNOH who has a special interest in, as well as responsibility for, patient experience and safety.

Amongst others in the Steering Group are: Lewis Kendall, Senior Charge Nurse; Paul Gunning, Consultant Anaesthetist and Director of Clinical Governance; Hanny Anwar, Consultant Spinal Surgeon and Roxaneh Zarnegar, Consultant Anaesthetist.  

Next steps

For the Rounds to be implemented at RNOH, the clinical leads and facilitators will receive training in November with the hope that we can launch a pilot Round in January 2016.

From my personal perspective, the timing of the introduction of these Rounds could not be better, especially given that parity of esteem between mental and physical health is being recognised as an important part of anyone’s health!

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