1. Schwartz Rounds
Your name
Organisation
Where and when

2. Structure of talk What is the problem? What can help?
What are Schwartz Rounds?
What is the evidence?
Next steps

3. What is the problem? A demanding healthcare environment
NHS funding constraints
Patient population – older, more frail and complex
High turnover of staff
High levels of organisational change and uncertainty
Short term relationships between staff and patients
Pressure to reduce lengths of stay
Staff working very long shifts.

4. What is the problem? (continued)
Pressures on staff wellbeing
The 2016 NHS Staff Survey told us:
37% of all staff reported feeling unwell due to work related stress and pressure.
60% of staff reported coming to work in the last 3 months despite feeling unable to perform their duties
Only 52% felt involved in deciding on changes in their team, department or work area.
72% of staff reported that their most recent experience of physical violence was at work.
60% said they would recommend their organisation as a place to work.
The Point of Care Foundation report Staff Care (2014) is a valuable source of data about NHS staff and the importance of providing staff with good support.

5. What is the problem? (continued)
Staff experience is a driver of patient experience
If staff are unsupported they are more likely to:
Withdraw from their work for emotional protection
Feel more isolated and stressed
Have a lowered sense of personal effectiveness
Feel emotionally exhausted
Depersonalise care.
These responses are likely to have a negative onward impact on the safety and quality of patient care (Maben et al, 2010; Raleigh et al. 2009).
What’s the result? Links between staff and patient experience
References:
 King's College London. National Nursing Research Unit
Does NHS staff wellbeing affect patient experience of care? Policy Plus ; Issue 39 (May 2013) London : King's College London, 2013
 This study, by researchers at the National Nursing Research Unit, set out to explore the links between patients’ experiences of health care and staff experiences (including motivation and well being) at work. The study is distinct from others that have looked at associations at the whole hospital level, focussing instead on the team/unit level, where possible matching staff to the individual patients they cared for. Strong links appear to be found between staff well-being, staff reported patient care performance and patient-reported patient experience, leading the authors to conclude that enhancing staff well-being can improve the quality of patient experience.
Raleigh VS, Hussey D, Seccombe I, Qi R.
Do associations between staff and inpatient feedback have the potential for improving patient experience? An analysis of surveys in NHS acute trusts in England.
Quality and Safety in Health Care. 2009 Oct;18(5):
 This study, based across 166 NHS acute trusts in England, aimed to examine whether staff feedback on quality, safety and workforce issues is reflected in patient-reported experience.
staff and patients responded to the surveys and analysis showed that staff feedback was associated with patient-reported experience. Positive staff feedback on availability of hand-washing materials was broadly reflective of positive patient experience. Negative staff experience was reflected in poorer patient experience and vice versa. Although causality could not be demonstrated, the consistent direction of the findings is indicative of it. The authors conclude that if responsible staff monitor and act on the results of their staff surveys it has potential for improving quality, safety and patient experience.
COI for the Department of Health
NHS Health and Well Being; the Boorman Report
Final report November 2009.
 The final report produced by the Boorman Review proposes changes to the way in which the health and well-being of staff within the NHS are managed. The report demonstrates clear linkages between staff health and wellbeing and the levels and quality of both patient care and patient satisfaction. The review found clear examples of Trusts securing enhanced performance by targeting improved staff support. Yet distinct and marked variations were evident between trusts and many staff were not convinced that their health and well-being is seen as important to their employer. The report provides recommendations to: improve organisation behaviours and performance; achieve an exemplar service and embed staff health and well-being in NHS systems and infrastructure.
“All NHS organisations will understand the positive impact that happy and engaged staff have on patient outcomes, including mortality rates, and will be making this a key part of their quality improvement strategy.” Keogh, 2013

6. What is the problem? (continued) Dr Kieran Sweeney, GP, academic and patient
“The health professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And in some cases rather dull.
For the individual patient it’s anything but that. Every individual that comes through a hospital is apprehensive. It’s a strange place, you lie in a strange bed, you have strange sheets, you have odd tea in a plastic cup. The whole thing is vibrantly different.”
“Mesothelioma: A patient’s journey” Sweeney, Toy and Cornwell: BMJ 2009
What’s the result?: Kieran Sweeney on poor communication
Dr Kieran Sweeney was a GP who died from cancer in 2010.
This moving film explores the impact on the patient of poor communication, and some of the reasons why health professionals may not communicate effectively with patients.

7. What helps? Interventions that aim to support staff in their work.
Ideally these should be:
Compatible with a systems perspective
Described in enough practical detail to be replicated elsewhere
Flexible, so they can it be adapted to different environments
Sustained or spread beyond the place where it originated
Subject to an external process of assessment or evaluation.
Reference: Adapted from Greenhalgh et al Goodrich J, Cornwell J 2008 Seeing the Person in the Patient King’s Fund.
Solutions and responses: effective interventions
When the Point of Care Foundation first started its work, it sought to find effective interventions (practical things organisations, teams and individuals could do) that would improve patients’ experiences; staff experiences – or both.
Point of Care studied the research into what makes good ideas spread and developed a list of criteria for identifying interventions it would promote (listed above)
Schwartz Rounds were one of the few interventions that assessed well against these criteria.

8. Schwartz Rounds Solutions and responses: Schwartz Rounds
One of the central initiatives which The Point of Care Foundation is championing, supported by a grant from the Department of Health, is the spread and support of Schwartz Rounds. The number of NHS trusts and hospices running Rounds continues to grow (check for latest figures). The image in this slide is a photo taken during a Schwartz Round at the Royal Free Hospital in London.
What is a Round?
Rounds are not problem solving – rather a supportive environment in which staff from all professional backgrounds can explore social and emotional aspects of care. Taking place for an hour, usually once per month, they offer staff a regularly scheduled time and place in which they can openly and honestly discuss social and emotional issues that arise in caring for patients. The focus of Rounds is on the human dimension of medicine.
The underlying theoretical foundation for Rounds, as first articulated by Kenneth Schwartz during his treatment for an aggressive form of terminal lung cancer was that compassion shown by staff to patients can make all the difference to a patient’s experience of care, but that in order to provide that compassion, staff must, in turn, feel supported in their work. Rounds are designed to provide this support, giving staff an opportunity to reflect on their experiences of delivering care, including both it rewards and frustrations – on what the Schwartz Center calls the ‘human dimension of care’.
Schwartz KB (1995) A patient’s story The Boston Globe Magazine, 16 July. Available from

9. Schwartz Rounds
Mentioned in the Francis Report as being something that
can improve team building.
Mentioned in NHS England Business Plan (2014) as evidence based initiative to improve patient experience
Now running in just under 170 healthcare organisations across the UK and Ireland.

10. Organisations running Rounds by type (May 2017) (n=169)
Acute 88
Community 6
Hospice 36
Welsh/Scottish 4
Prisons 1
Mental Health 10
Private 4
Education 4
Ireland 11
Primary Care 4
Although Schwartz Rounds were initially introduced into Acute Trusts, they are increasingly being run in diverse organisational sectors and settings.

11. What is a Schwartz Round?
Schwartz Rounds are a confidential, multidisciplinary forum designed for staff to come together once a month to reflect on the emotional and social experiences associated with their work.
ALL STAFF are invited (clinical and non-clinical), recognising that each individual has something to contribute
They follow a specified, evidence-based format
The focus is not on the clinical aspects of the patient, but on staff experience
No answers or expertise are sought
Solutions and responses: Schwartz Rounds (format)
A short video of a demonstration Round can be found on our website

12. Format of a Round
Food is always provided at Rounds as it demonstrates that the organisation values its staff and their time
Round lasts for 1 hour in total
The presenting panel share their experiences for minutes
Trained facilitators then moderate a reflective discussion
The audience share their thoughts, ask questions, offer similar experiences
The discussion does not aim to problem-solve or find solutions, but just reflect on the emotional experience of delivering care. This can feel counter- cultural.

13. Schwartz Round topics Each Round has a topic. For example:
Trying to help in impossible circumstances
Conflict – with patient; family; colleagues
‘Unrewarding patients’
Rewarding patients and perils associated with them
Organisational events, e.g. poor CQC report or a major complaint
We’re human too – personal and professional overlap
The patient I’ll never forget.
Schwartz Rounds detail: Round themes
Rounds can either be based on different accounts of one patient or event, or can explore a particular theme

14. Who is involved?
Two facilitators (minimum time commitment 1day/month) who will prepare the panel and facilitate the Rounds.
One clinical lead (minimum time commitment half day/month) who will co-facilitate the Rounds.
Administrator (minimum time commitment 1day/month) who will organise the Rounds and steering group meetings.
A steering group (time commitment half day/month) who will meet once a month and attend the Rounds.
The board will need to fully support the initiative and the internal resource required, including provision of venue and catering.
Solutions and responses: Schwartz Rounds (requirements)
To successfully run Rounds in your organisation, a number of key individuals need to be identified.
Job specifications for the facilitator and clinical lead can be supplied by the PoCF. It is likely that the facilitator and administrator may need to commit around one day a month to preparation and setting up the Rounds. The clinical lead will need at least half a day, as will the steering group. If this time can be agreed and protected in advance it means that the Rounds have more chance of sustainability. The organisation also needs to provide lunch for the staff invited to attend the Round and a room in which they can take place

15. What is the evidence?
Two key studies (Lown & Manning, 2010, and Goodrich, 2011) have shown that staff who participated in Rounds (especially those who attended regularly) reported:
Decreased feelings of stress and isolation
Feeling valued
Improved team-work, connectedness and communication
Greater appreciation for other disciplines / roles
More openness to giving and receiving support
Diminished hierarchies between senior and junior staff
Increased feelings of compassion towards patients
Increased attentiveness to social and emotional aspects of patient care.
Schwartz Rounds detail: Impact of Rounds
Evaluation of Rounds shows that they have a unique and profound impact on participants and on their host institutions. Staff who participated in multiple Rounds sessions reported:
- Increased insight into social and emotional aspects of patient care; increased feelings of compassion towards patients; and increased readiness to respond to patients and families’ needs.
- Improved teamwork, interdisciplinary communication and appreciation for the roles and contributions of colleagues from different disciplines
- Decreased feelings of stress and isolation, and more openness to giving and receiving support.
In many cases, participants reported that insights gained at Rounds led to the implementation of specific changes in departmental or hospital-wide practices or policies to benefit both patients and providers. The study also found that the more Rounds caregivers attended, the greater the benefits they experienced.
Lown BA and Manning MA (2010) ‘The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centred communication, teamwork and provider support.’ Academic Medicine, vol 85, pp
Schwartz Rounds detail: Impact of Rounds (continued)
The UK evaluation consisted of quantitative and qualitative elements. Attendees at rounds filled in evaluation forms at the end of each session in which they are asked to assess the likely outcomes of attending rounds.
Results were gathered over a one year period from 10 Rounds held at Cheltenham and the Royal Free. The average number of attendees at Cheltenham was 30 per round with 95 at the Royal Free. 222 Evaluation forms in total were collected at Cheltenham (74% response rate, with 691 collected at the Royal Free (69% response rate).
A more robust piece of UK based research funded by the National Institute of Health Research Health Services and Delivery Research Programme (NIHR HS&DR) is currently underway and aims to uncover to what extent participation in Schwartz Centre Rounds affects staff wellbeing at work, improves relationships between staff and patients, and aids the provision of compassionate care in the UK. The study, entitled, ‘Supporting NHS staff at work: Could Schwartz Centre Rounds hold the hold the key to a happier, healthier workforce and enhance compassionate care?’ will be conducted by a team of researchers at the Florence Nightingale School of Nursing and Midwifery and led by Professor Jill Maben, Director, National Nursing Research Unit.
References:
Goodrich, Joanna ‘Supporting hospital staff to provide compassionate care: Do Schwartz Centre Rounds work in English hospitals?’JR Soc Med 2012: 105:
Maben, Jill ’Staff must be supported to put patient care first’ HSJ October 2013
Goodrich, Joanna ‘Schwartz Rounds provide a dedicated time for reflection’ Nursing Times.net. 16 July 2013

16. Feedback from Rounds Schwartz Rounds detail: Feedback from Rounds
Rounds appear to have successfully transferred to England where they have met a demonstrated need and appear to be greatly valued by staff. In organisations where there is clear support from; the Board, a senior clinician and a dedicated and proficient facilitator - Rounds have become embedded in the culture of the organisation.  
Hospitals are complex and challenging places and Rounds are one of a number of ways by which, senior staff and trust boards can signal that care is a priority and show that they recognise the demands on individuals. Whilst they don’t replace good teams they do provide space to reflect on the nature of work.
Staff need to be given the means and support to withstand pressures of working in a highly charged working environment. Evidence suggests that:
- Rounds build staff resilience
- Change hospital culture
- Impact positively on patient care
- Strengthen the ability of staff to show compassion

17. Feedback from Rounds

18. Impact of Schwartz Rounds (Continued)
What did participants say?
INSERT FROM CHOICE OF QUOTES BELOW
Quotes from the qualitative research [Copy and paste into the slide quotes you would like to use]
“I really appreciate the language. You hear words used you don’t normally hear such as anger, guilt, shame and frustration. They are obviously there but there is no outlet for them”
There is always hierarchy in a hospital but in a room like that you are all carers in a caring environment. Your opinion is always listened to
In the context of mid-Staffs, staff are expressing things and the Rounds are a sign that it is safe to speak. It is all very well to say we have an open culture, but this demonstrates that value
Nursing staff, physios, all staff really, say they have a greater sympathy for doctors, who seem less cold and hard. And doctors have greater respect for the rest of the team as they appreciate what they do and what they are having to take home with them.
The Rounds are not linked to targets. It counterbalances some of the target stuff and humanises the mix
Schwartz Centre Rounds

19. Next steps Go to our website and download an information pack
Contact the coordinator to discuss further and to arrange to observe a Round
Identify a facilitator, clinical lead and administrator
Identify members of the Steering Group
Get board support to sign contract and pay for support from The Point of Care Foundation
Attend training
Note: only organisations supported by The Point of Care Foundation are authorised to run Schwartz Rounds.
Schwartz Centre Rounds

20. Programmes coordinator
Contact details
Aggie Rice
Programmes coordinator