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Support for Compassionate Care: Quantitative and Qualitative Evaluation of Schwartz Center Rounds in an Acute General Hospital

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Support for Compassionate Care: Quantitative and Qualitative Evaluation of Schwartz Center Rounds in an Acute General Hospital Research Journal of the Royal Society of Medicine Open; 0(0) 1–8 DOI: 10.1177/2054270416648043 Support for compassionate care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital Raymond J Chadwick1, Steven J Muncer1, Bronagh C Hannon2, Joanna Goodrich3 and Jocelyn Cornwell3 1Department of Clinical Psychology, Teesside University, Middlesbrough, UK 2School of Psychology, Newcastle University, Newcastle upon Tyne, UK 3The Point of Care Foundation, London, UK Corresponding author: Raymond J Chadwick. Email: [email protected] 1 Abstract of increasing pressure on performance. Objective: To evaluate the impact of Schwartz Center High levels of stress are evident among frontline 2,3 Rounds, a multi-disciplinary forum to reflect on the emo- staff, with the attendant risk of burnout. tional consequences of working in healthcare, on the staff Yet these same staff hold the main responsibility of a large acute general hospital over a three-year period. for providing the compassionate care which is Design: Evaluation data following each Round were col- widely and rightly valued – the kind of care we lected routinely from all staff attending over this period would all want for our ‘friends and families’.4 and analysed quantitatively and qualitatively. There is growing recognition of the relationship Setting: An integrated university teaching trust with both between the well-being of staff and the well-being acute hospital and community services in the North East of of patients for whom they care.5,6 Increasing atten- England. tion is paid to staff well-being, and in this context Participants: Over the three-year period of the study, 795 participant evaluation forms were returned by staff attend- Schwartz Center Rounds are attracting widening ing the Rounds. interest. Main outcome measures: A standard evaluation form com- Schwartz Center Rounds (‘Rounds’) provide a pleted at the end of each Round by those present, including multi-disciplinary forum for staff to meet on a ratings on a five-point scale against each of eight statements monthly basis to discuss and reflect on the personal and an opportunity to offer additional free text comments. and emotional impact of working in healthcare. Results: The findings show a very positive response to all They are open to all staff employed in the organisa- aspects of the Rounds by staff who attended. The most tion, whether clinical or non-clinical. Rounds highly rated statement was: ‘I have gained insight into were first developed by the Schwartz Center for how others think/feel in caring for patients’. This was rein- Compassionate Healthcare in Boston, USA in the forced by the qualitative analysis in which the primary late 1990s and have steadily expanded. They are theme was found to be Insight. There were no significant differences between disciplines/staff groups, indicating that now established at over 350 healthcare organisations all staff whether clinical or non-clinical responded to the throughout North America. Rounds equally positively. In 2006, an evaluation of the impact of Rounds on Conclusions: Schwartz Rounds are highly valued by staff participating staff was commissioned by the Schwartz from all disciplines, and by managers and other non- Center, Boston. The findings indicated that staff who clinicians as well as clinicians. They appear to have the attended a number of Rounds reported increased potential to increase understanding between different insight into social and emotional aspects of care; staff, and so to reduce isolation and provide support. improved teamwork/communication; appreciation of the roles of colleagues from different disciplines Keywords and decreased feelings of stress and isolation.7 The empathy, compassion more Rounds that staff attended, the greater the benefit they experienced. In addition, there was evi- Introduction dence that insights gained through Rounds led to specific changes in departmental and even hospital- The quality of care and patient safety in the NHS wide practices, to the benefit of both staff and are under scrutiny as never before, in a context patients. ! 2016 The Author(s) Creative Commons CC-BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www. creativecommons.org/licenses/by-nc/3.0/)'RZQORDGHGIURP which permitsVKUVDJHSXEFRP non-commercialDW7HHVVLGH8QLYHUVLW\/LVRQ-XO\ use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://uk.sagepub.com/en-us/nam/open-access-at-sage). 2 Journal of the Royal Society of Medicine Open 0(0) In 2009, The Point of Care Programme at the from different disciplines – spend around 20 minutes King’s Fund entered an agreement with the presenting a patient story, or talking about a topic Schwartz Center to undertake a pilot of Rounds in related to their work. The emphasis throughout is on the UK, working with two NHS acute hospital trusts. the personal and emotional impact of their work, and The purpose was to ascertain whether they would only touches on the detail of clinical management as have a similar impact on participants to those necessary to explain the story. reported in the USA. Evaluation of the pilot study A Round lasts for one hour, and for the remainder took the form of before and after online surveys of of this time the discussion is opened up to all those participants, and feedback sheets completed after attending under the guidance of two facilitators, a each Round8; and qualitative interviews with a clinical psychologist and a doctor. It is emphasised sample of regular participants.9 The findings indi- that the purpose is not to solve problems but to cated that Rounds at the pilot sites had a positive reflect on the stories told, and to share experiences impact on individuals who attended; on staff relation- these may have brought to mind. The need for con- ships and team functioning and on the wider hospital fidentiality is stressed, in relation to any patient stor- culture, by building and supporting shared values. ies, and to any participants speaking during the Overall, it was concluded that Rounds could transfer Round. The intention is to provide a safe environ- successfully to the UK, and that they were firmly ment in which staff feel able to talk freely. (These established and valued by staff at all levels at the principles are all shared in common with other cen- two pilot sites. tres where Schwartz Rounds are held.) Responsibility for Schwartz Center Rounds in the At the first Round held at South Tees, three senior UK has now passed to The Point of Care members of the medical staff each spoke about a Foundation, an independent charity established in memorable patient, where the outcome had not 2013. The number of UK organisations contracted been good. They talked about their immediate reac- to hold Rounds has grown quite rapidly, and cur- tions when something went seriously wrong, and rently stands at around 120 NHS trusts and hospices. about their lingering feelings of responsibility. The Several accounts of the impact of Rounds have been title of the Round was: ‘Does this make me a bad published, all favourable and all to date within hos- doctor?’ There was complete silence as they spoke. pice settings.10–12 Two accounts report brief descrip- Staff in the audience said later that it had altered tive statistics, from data collected over a 12-month their views of the three speakers and of doctors gen- period, and one of these also reports the findings of erally – as being human and having feelings like four interprofessional focus groups. everyone else. Other Rounds since then have seen In the present study, quantitative and qualitative numerous patient stories; presentations by several analysis is undertaken of all the evaluation data col- teams including Palliative Care, Organ Donation lected from Rounds held in an acute NHS trust over and the Acute Assessment Unit and a group of a period of just under three years. junior doctors talking about their experiences on night shifts. Schwartz Center Rounds at South Tees Rounds are held in the middle of the day, and a simple lunch is provided beforehand. The number of South Tees Hospitals NHS Foundation Trust pro- staff attending over the period of the study ranged vides district general hospital services for the local from 56 to 97 (mean attendance 71.3). The aim is to population, and also a range of community services. hold 10 Rounds each year – on a monthly basis apart In addition, it offers a number of specialist regional from August and December. Feedback is requested services to 1.5 million people in the Tees Valley and from each individual attending by means of a one surrounding area, with a particular expertise in heart page evaluation form (see Figure 1), which is com- disease, neurosciences, children’s services, renal medi- pleted immediately the Round ends. The responses cine, cancer services and spinal injuries; and it is the on these evaluation forms collected over a three-year major trauma centre for the southern part of the period are the subject of the remainder of this paper. northern region. It has a total workforce of around 9000. Schwartz Rounds were first introduced at South Evaluation of rounds at South Tees Tees in January 2012, following the guidelines devel- Respondents oped by the Point of Care team at the King’s Fund from the work of the Schwartz Center. All staff in the Over the course of 18 Rounds in a period of just under Trust whether clinical or non-clinical are invited to three years, 795 responses to the evaluation form were attend. A panel of three to four speakers – usually collected.
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