Analysis

Schwartz rounds: bringing staff together to improve well-being and promote better patient care

Findings from a study into the effectiveness of Schwartz rounds suggest that staff who attend are less stressed and more empathic with colleagues and patients

Findings from a study into the effectiveness of Schwartz rounds suggest that staff who use this opportunity for group reflection are less stressed and more empathic with colleagues and patients.


Staff at the Walton Centre NHS Foundation Trust, Liverpool, taking part in a Schwartz round

The study was commissioned by the National Institute for Health Research.

University of Surrey professor of nursing Jill Maben led a team from her university as well as King’s College London, the University of Sheffield and the King’s Fund.

Over eight months, they assessed the psychological well-being of 500 staff who attended Schwartz rounds regularly, irregularly or not at all.

Schwartz rounds are regular meetings, which are usually held once a month or so, when staff from across discplines can come together to have an hour’s discussion.

Advance notice

Topics are usually advertised in advance, when invitations to attend are sent out, and can be anything from a particular incident that everyone present was involved in, to a set theme such as ‘a patient I remember clearly’ or a more general ‘when things go wrong’.

50%

Drop in percentage of staff reporting psychological distress

The researchers found that the well-being of staff who attended the rounds regularly improved, with the proportion of those with psychological distress halving, from 25% to 12%. There was little change among staff who attended meetings only occasionally or not at all.

When asked, most interviewees said Schwartz rounds had been introduced because it was thought that their organisation needed to focus on improving staff well-being.

The research team noted wide variation in how rounds were implemented and several challenges to their sustainability.

Achieving regular attendance, particularly widening accessibility for staff who had less autonomy to manage their own time, was of primary concern.

Costs and staff time

The costs involved in providing rounds and the amount of staff time required also varied considerably.

The total time administrators, facilitators and clinical leads needed to devote to holding rounds ranged from seven to 82 hours a month, with a mean of 28 hours, and costs ranged from £380 to more than £4,470 a month.

Participants at rounds were also interviewed and described the experience as ‘interesting’, ‘engaging’ and ‘a source of support’.

Many appreciated the opportunity to learn more about their colleagues, understand their perspectives and motivations, and engage in multidisciplinary interaction. ‘This led to feelings of greater understanding, empathy and tolerance towards colleagues and patients,' the report states.

'Schwartz rounds are an opportunity to engage with colleagues'


Lisa Salter

Neither deputy director of nursing Lisa Salter nor matron for safeguarding Clare James, both at the Walton Centre NHS Foundation Trust, Liverpool, doubt about how vital such meetings are.

‘Staff say it’s lovely to have an opportunity to engage with colleagues and talk about really emotional times and how they felt experiencing them,’ says Ms James.

‘There is also the chance to gain useful insight into how others felt when encountering a particular patient and to draw on that insight if you encounter a similar type of patient in future.’


Clare James

The trust uses a steering group to plan the content of Schwartz rounds and to advertise topics in advance so that participants can prepare.

Ms Salter adds: ‘We distribute fliers seeking feedback on how each round has gone and 92% of staff who attend say that what was discussed was directly relevant to their daily tasks.’

 

However, some participants questioned the purpose of unearthing feelings of sadness, anger and frustration.

Others also highlighted barriers to attendance such as conflict with other clinical priorities and having no one to cover their work for them.

170

The aprroximate number of organisations in the UK and Ireland using Schwartz rounds

Senior staff who chair the meetings were seen as important figures in championing Schwartz rounds and motivating others to be involved.

Asked to sum up how they thought rounds differed from the more specific reflection meetings and performance reviews associated with a particular job and revalidation, most noted how rounds move beyond factual clinical details about patients to encourage emotional disclosure.

Positive culture change

Time and lack of financial resources were also highlighted as the challenges senior staff faced most often when preparing rounds meetings.

The licence to train and support organisations to provide Schwartz rounds is held by a charity called the Point of Care Foundation.

One of its trustees is Robert Francis, who conducted the inquiry into care failings at Mid Staffordshire NHS Foundation Trust, in 2013. One of his recommendations was for care providers to run regular Schwartz rounds to bring about positive culture change by bringing staff together for the benefit of patients.

Around 170 organisations in the UK and Ireland have subsequently done so, with Professor Maben’s research noting there was a particular peak in uptake around the time the inquiry findings were published.

Responding to the research, Sir Robert says: ‘Schwartz rounds can be transformative of a healthcare organisation's culture.

‘They bring teams together, improve morale and self-esteem, and foster openness.

‘It is gratifying to see such a thorough independent study confirming that Schwartz rounds make a significant contribution to supporting NHS staff, particularly at a time when the service is under such huge pressure.’

Food is ‘mandatory’ at such meetings, as matron for safeguarding at the Walton Centre NHS Foundation Trust, Liverpool, Clare James explains: ‘While the experience is undoubtedly valuable, we are asking people to give up their time to attend.

‘It is right that we feed them, and nice that they get to have a break, have something to eat and have a discussion all at the same time.’

Confidential discussion

Professor Maben’s study found that Schwartz rounds help staff to feel more empathy towards patients and Walton Centre NHS Foundation Trust deputy director of nursing Lisa Salter says she sees this out on the wards.

Ms Salter adds: ‘A patient actually remarked to me about how well staff looked after patients and asked what avenues we had to discuss their cases.

‘I told him about Schwartz rounds and that they were a confidential forum where we get to say what we felt looking after a particular person.'

Asked what challenges they had experienced in creating and maintaining rounds, Ms James admits: ‘At times, it can be tough to get people to attend, especially when it’s been particularly busy on the wards.

‘But we always make staff aware that the meeting will go ahead even if numbers are down, because it is so important to us to make them aware of how much we value the opportunity rounds provide.’

Dates for the diary

The Point of Care Foundation is running two Schwartz rounds conferences in 2018, one in London on 23 January and one in Manchester on 6 February.

Following the success of the inaugural Schwartz Awards in 2016, the event will be making a return and will showcase shortlisted entries during the day before winners are announced.

To book a place on either conference click here

 

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