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Psychiatry School Conference

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1 Psychiatry School Conference
The Schwartz Center Rounds: supporting people who work within a mental health NHS Trust with the emotional impact of their work Psychiatry School Conference November 2013 Lyndsay Swift Dr Rob McFarland

2 Aim of the presentation
Introduce the Schwartz Rounds Where they came from and what they are How they may support professionals What they hope to achieve How they are run Introduce the research Present findings

3 Introduce the Schwartz Rounds
Where they came from: Ken Schwartz A Health analyst in the USA Attended hospital for treatment of lung cancer Found the treatment good, but no support for the emotional impact of getting the diagnosis Returned to work and explored this and the Schwartz Rounds were born!

4 What are the Schwartz Rounds?
Widely used in the USA Schwartz Center Rounds® The Schwartz Center for compassionate healthcare Brought to the UK by The Kings Fund The Point of Care programme

5 What are the Schwartz Rounds?
The Rounds came from oncology/physical health settings They have been run in: Palliative care Hospice Heart surgery wards (Royal Brompton Hospital) National spinal injuries ward (Stoke Mandeville) Our Trust is the first to apply the Rounds in mental health Dealing with emotion IS the work!

6 What are the Schwartz Rounds?
A monthly meeting, for 1 hour, for a defined group Lunch HAS TO be provided An open meeting A space and a place to discuss the emotional impact of the work we do They are NOT clinical Supervision (group or individual) They are NOT a de-brief They are NOT a place to problem solve or discuss care planning They are a place to BE WITH how work affects us and to share how we feel

7 What are the Schwartz Rounds?
Each Round has a dedicated speaker(s) (Volunteers!) Speakers speak for about 15 minutes on their chosen topic area The remaining 45 minutes are for the Round attendees to: Share how they felt about the topic Share their experience of a similar situation Share how they would have felt in that situation

8 What are the Schwartz Rounds?
Each Round has a Chair: For us, this is a ward manager (nurse) Each Round has a facilitator: For us, and for most of the Rounds in the UK, this is a Clinical Psychologist The facilitator meets with the speakers prior to the Rounds, to ‘run through’ the Rounds, so people feel safe Each Round has a Steering group

9 What they hope to achieve
Cathartic? De-shaming? Understanding of each others roles? Affirmation of the reasons why we come to work? Sharing a common humanity? A recognition from the organisation that work has an emotional impact A recognition that time is needed in work to process/discuss the emotional impact of the work Caring for the people that care

10 What is Compassion? “…a sensitivity to the suffering of self and others, with a deep commitment to try to relieve it.” The Dalai Lama (1995)

11 Components of Compassion
WARMTH WARMTH We can all benefit from adopting an observing, accepting, non-judgmental stance! Attitude/way of being as compassionate, respectful, empathic, hopeful  foster a genuine caring about each other and ‘problems of human living’; as simple as going out of your way or taking time/a moment to ask “How are you doing?”, an attempt to understand as more informative and helpful than judgements we make. “It is the relationship that heals…” WARMTH WARMTH Adapted from Gilbert (2009)

12 What gets in the way of being compassionate
What gets in the way of being compassionate? Looking beyond the individual Organisations may encourage compassion or stifle it. Competitive business culture – drive for efficiency: demands & pressures upon patient care can hinder professionals’ ability to provide a compassionate service, which can mean less 1 to 1 patient care (Sanghavi, 2006) Reward systems or threat systems (linked to targets) employees are likely to be most stressed when they experience high demands, have little control over workload & low support (Evans et al., 2006: Citing Karasek (1979) Time demands, bureaucratic paperwork (defensive practice) These all create unpleasant & draining work environments for service users & employees

13 Potential benefits of giving compassion care
Compassionate clinical relationships prevent health problems & promote faster recovery (Hamilton, 2010) Patients are more likely to disclose concerns, symptoms & behaviours, helping to inform treatment plans, improve outcomes & increase satisfaction. (Halpern, 2001; Larson, 2005; Sanghavi, 2006). Relationships can be enhanced across professions, leading to greater awareness of cultural beliefs & more supportive environments for staff (Lown & Manning, 2010)

14 Potential benefits of giving compassion care
Boyatzis et al., 2006: creativity and decision making can also be enhanced in less stressful environments, where people feel more supported within their organisation The Health of the Nation (Secretary of State for Health; 1992): health improvement and promotion strategies within the workforce at large can be significant in developing improvements in overall health.

15 Potential benefits of giving compassion care
Prosser et al.; 1996: Mental health professionals commonly face highly emotive situations: supporting people who are suicidal and who may have made attempts upon their life. experiencing threats of violence in their day to day lives

16 Matthieu Ricard “…even though there can be “empathy fatigue,” there cannot be “compassion fatigue,” since compassion is essentially a wholesome, positive state of mind, while empathy is only the tool that allows one to correctly perceive the state of mind of others. The more one experiences compassion and loving kindness, the more one progresses towards authentic well-being, and becomes unconditionally available to others...”.

17 Potential benefits of giving compassion care
“By developing health care systems that facilitate compassionate care, our patients' experiences & clinical outcomes will be better, our own risks of burnout or litigation will be less, & our job satisfaction will be considerably greater” (Cole-King & Gilbert 2011)

18 Our Rounds Backed by the Kings Fund
Pilot of 6 months in acute mental health care (Radbourne Unit, Derby) November 2011-April 2012 93 people attended at least 1 Round (from 150 people invited; 62%) 33 people attended more than 1 Round (35% attendees; 22% of everyone invited)

19 Our rounds 3 sites: - Derby (Radbourne Unit)
- Chesterfield (Hartington Unit) - HMP (Prison Inreach) Attendance across MH sites: - Total = 270 - 31% attended more than 1 round


21 Round topics “He’s going to kill me…what should I do?”
- A professional’s experience of being attacked by a service user “A day at work I will never forget” - A professional discussing a day when a service user had her children taken away from her “Too close to home” - A professional’s experience working with a service user who had similar difficulties to their relative

22 Round topics “The lonely walk” “I’m pregnant!”
- A professional talking about what it was like doing ward observations, believing the patient would kill themself “I’m pregnant!” - A professionals experience of working in MHS whilst pregnant “Positive risk taking, a frightening experience” - An OT’s perspective facilitating discharge into the community



25 Words used to summarise rounds
engaging insightful emotional connecting supportive reflective validating honest empathetic worthwhile refreshing essential normalising enlightening

26 Comments from the Rounds
The rounds were useful: The expression of emotion Sharing how people feel Validation of feelings “Enjoyed reflecting on emotions and hearing different professions very similar view points. Sharing experiences, validating emotions, talking openly.” ‘Pat’ “you’ve got a chance to vent your positive and your negative feelings in quite a protective place”

27 Comments from the Rounds
‘Ann’ “…his reflections helped us to think about if we had been in that situation how we’d sort of coped with it and things” Relevant to everyday issues: ‘Pat’ “last week’s was quite powerful for us…I think that was because it was very clinical based. It sort of touched on a lot of things a lot of us have gone through” ‘Pat’ “it’s something that we can relate to our practice, that one [referring to a particular Round] was very in touch with what we’re doing today”

28 Comments from the Rounds
Food: Feeling valued Management commitment to compassion ‘John’ “[Food is an incentive]. It invites a group…I think it gets people there, it’s an opener I think and creates an atmosphere of caring” “Often we come in our lunch time …because they don’t have lunch [on the ward], they have to have it running” ‘John’ “someone’s put money into it, which is about corporate will…because they don’t do that in any other forum…I don’t if other people would perceive it as that but for me that stood out”

29 Comments from the Rounds
Negative views: Pat’ “because of timing, I was in charge of the afternoon shift so I had to go [fifteen minutes before the end] so we didn’t see the end of it and a student nurse came with me and when we both…left and [said], ‘whoah, that was quite powerful and emotional’ but you had to go back to the ward and get back into the hustle and bustle of it all” Sharon’ “…we come in and listen to somebody put …their story and their experiences and I think everyone in the room could relate to that in a way, but then we go away, we go back to work but we don’t always get that chance to say ‘oh yeah…I could relate to that’. I think if you went to every one, if everyone had an opportunity to say their piece as well, it’d feel more rounded”

30 Comments from the Rounds
The Rounds have room for improvement: ‘John’ “it is very hard to get people consistently to [attend]. It’s a big unit, the shift system, very busy, demands to go back, so the fact that it happened…to get that many people there was pretty good” ‘Pat’ “now more people are getting to know that they’re there, I think more people are trying to make the effort to try and get to them”

31 Comments from the Rounds
‘Ann’ “I think it can be quite intimidating to speak up in a room where there’s lots of people from lots of different teams. If this sort of thing was happening within the team that you worked [in], you might feel more comfortable to put your point of view across but you might think ‘I don’t know if this is going to come across right or there’s lots of people looking at me, is it ok for me to say this?’. Obviously it’s made clear that everybody’s contribution is welcomed and as much is done as can be to try and make people feel relaxed.” ‘Jane’ “I don’t think enough people know about it for it to have had an impact necessarily on the wards at the minute”

32 References Boyatzis, R., Smith, M. & Blaize, N. (2006). Developing sustainable leaders through coaching and compassion. Academy of Management Learning and Education, 5, 8-24. Cole – King, A. & Gilbert, P. (2011). Compassionate care: the theory and the reality. Journal of Holistic Healthcare, Vol 8 (3) 29-37 Cornwell, J. (2009). See the person in the healthcare professional: how looking after staff benefits patients. Nursing Times, 105 (48), 10-12 Cornwell, J. & Goodrich, J. (2010). Supporting staff to deliver compassionate care using Schwartz Centre Rounds- a UK pilot. Nursing Times, 106 (5), 10-12 Dalai Lama (1995). The Power of Compassion. India: Harper Collins. Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge: London.

33 References Evans, S., Huxley, P., Gately, C., Webber, M., Mears, A., Pajak, S., Medina, J., Kendall, T. & Katona, C. (2006). Mental health, burnout and job satisfaction among mental health Social Workers in England and Wales. British Journal of Psychiatry, 188, Karasek, R. (1979). Job demands, job decision latitude and mental strain. Implications for job redesign. Administrative Quarterly, 24, Lown, B., Manning, C. (2010). The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centered communication, teamwork, and provider support. Academic Medicine, 85 (6), Matthews D.A., Suchman A.L., Branch W.T. (1993). Making “connexions”: Enhancing the therapeutic potential of patient-patient-clinician relationships. Annals of Internal Medicine, 118, 973–977. Prosser, D., Johnson, S., Kuipers, E., Szmukler, G., Bebbington, P. & Thornicroft, G. (1996). Mental health ‘burnout’ and job satisfaction among hospital and community-based mental health staff. British Journal of Psychiatry, 169,

34 References Sanghavi, D. (2006). What makes for a compassionate patient-caregiver relationship? Journal on Quality and Patient Safety, 32 (5), Secretary of State for Health (1992). The Health of the Nation. A Strategy for Health in England. London: HMSO. The Schwartz Center for compassionate healthcare. ( Thi, P., Briaçon, S., Empereur, F. & Guillemin, F. (2002). Factors determining inpatient satisfaction with care. Social Science & Medicine, 54,

35 Thank you for listening
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