Schwartz Rounds allows healthcare professionals to explore and discuss difficult emotions and could help boost morale and patient care in the NHS, writes Carol Davis
A groundbreaking workforce scheme that allows NHS staff to use real cases to explore difficult feelings and stressful situations can help tackle low morale in the NHS and promote better patient care.
US lawyer Kenneth B. Schwartz developed the Schwartz Center Rounds® following a lung cancer diagnosis as a means of bringing health professionals together to discuss their dilemmas in a mutually supportive way, with a focus on compassionate care.
Using the concept of a consultant's rounds, the scheme encourages interdisciplinary dialogue – across an entire hospital rather than just a clinical team – using real patient cases to enable participants to explore their own responses and feelings. The hour-long confidential sessions, which are open to staff across an entire hospital and have board level support, focus on an anonymised patient case which staff discuss to explore their feelings.
In one session, a senior nurse talked about how she had felt about a case early in her career, which one participant said "was good for junior staff to see that senior staff have the same dilemmas and difficulties, and don't always have the answer."
Having a multidisciplinary session which included staff from across the hospital also brought surprising insights and anomalies: an aggressive patient might have been extremely courteous to a consultant; or a porter might say they had to explain to a patient what a doctor had said because the patient only pretended to have taken in what their doctor had said.
Researchers at the King's Fund say the model has successfully transferred to the UK, say researchers at the King's Fund. Originally piloted at the Royal Free and Cheltenham hospitals, the rounds are now running in six UK hospitals and another has just been added, with plans for more through the year. The scheme is also now being extended to hospices to improve nursing and medical care.
"There are high levels of stress in the NHS compared to some other occupations," says Joanna Goodrich, programme manager for the point of care programme at the King's Fund, which has also just evaluated the UK rounds.
"Although staff want to provide the sort of kind, compassionate care that they would want for themselves or their own families, it's difficult for all sorts of reasons to do this consistently. Rounds help staff to reflect on the nature of the emotional and social challenges involved, and to support each other."
A point of care workshop found that barriers to compassionate care included staff stress and burnout; conflict between perceptions of professionalism and compassion; a lack of systematic role modelling or mentoring; and training that emphasises professional detachment, as well as natural defences staff develop to cope with continuous exposure to patients in pain and distress.
Despite some initial scepticism, the scheme has worked well in England, says Barbara Wren, consultant lead psychologist in health and work at the Royal Free Hampstead NHS trust. "The rounds help staff to reconnect with the most valuable aspect of their work – their clinical role – and allows them to witness compassion, care and the humanity that drives healthcare staff to go the extra mile, which is motivating and rewarding in these tough times."
There were some initial concerns that an approach from America would not work in a UK context, but these have proved to be unfounded: "We know from our evaluation that staff who attended really welcomed the opportunity to talk openly about the challenges and difficult emotions associated with caring for patients," says Goodrich.
At the Royal Brompton and Harefield NHS foundation trust, Dr Caroline Shuldham, director of nursing and clinical governance, says "the sessions put everyone on an equal footing." "If you are a leader, it helps you learn more about the experiences of colleagues dealing with difficult situations, and the long lasting impact patients can have."
Carol Davis is a Liverpool-based freelance health and travel writer
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