What are Schwartz Rounds?

Joanna Goodrich, Fellow, The Point of Care programme, The King’s Fund, London UK, explains how Schwartz Center Rounds can help staff to feel valued and improve relationships with their patients and colleagues.

Joanna Goodrich

People who are caring for patients and their families when they are suffering, in pain, or dying, have to draw on reserves of empathy and compassion – day in, day out – and this is challenging and draining. Staff may begin to feel stressed, or depressed, or even suffer from burnout and then feel that these reserves are being depleted. To compound their distress, too often (as we have seen recently in the British media), they are blamed for not being caring enough, rather than recognised, valued and supported in what they do.

The Point of Care programme at the King’s Fund  was established six years ago with the aim of improving patients’ experiences – but we soon realised that for that to happen we needed to improve the way staff are cared for. Looking for initiatives that encourage compassion we came across the Schwartz Center for Compassionate Healthcare in Boston, Massachusetts.  This not-for-profit organisation was set up in memory of Kenneth Schwartz, a patient who died from lung cancer at a young age. He had written movingly about his care describing how small acts of kindness ‘made the unbearable bearable’. He saw though, that for the carers, this required ‘giving of themselves’ in a way that was not easy and deserved support.

One of the first initiatives the Center ran was ‘Schwartz Rounds’. These are a forum for clinical and non-clinical staff from all backgrounds and levels of an organisation to come together once a month, for one hour, eat lunch or breakfast together, and explore the impact that their job has on their feelings and emotions. A team who have cared for a patient tell their story and this is followed by discussion, open to all, exploring issues that have arisen. It is not about problem solving – rather it is a dedicated time for reflection and a safe place to voice feelings not often shared, such as frustration, anger, guilt, sadness, joy, gratitude and pride. Sitting in on Rounds all over the country I have been moved, time and again, by the commitment of staff, and humbled by their stories of how they have gone the extra mile for their patients – and seen what that has cost them.

In the US, about 300 organisations run Schwartz Rounds. Here in the UK, the King’s Fund piloted the Rounds successfully in two hospitals in England in 2010 and so far there are now 15 hospitals and seven hospices running Rounds, all with the support of their chief executive and boards, and organised by a multidisciplinary group with a senior doctor as the lead. Rounds attract between 20 and 200 people at a time.

Instinctively, sharing stories with colleagues about the high cost of caring feels like a good thing. But evaluations (Goodrich 2012, and Lown 2010) back this up and have shown that the Rounds have a positive impact on individuals and their relationships with patients and colleagues, and staff feel cared for by their organisation.

References
Goodrich J. (2012) Supporting hospital staff to provide compassionate care: do Schwartz Center Rounds work in English hospitals? Journal of the Royal Society of Medicine 105:117-122.

Lown BA, 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):1073-1081.

To find out more…

• King’s Fund Centre Schwartz Center Rounds.
• This post also relates to an article, ‘Supporting hospice staff: the introduction of Schwartz Center Rounds to a UK hospice setting’ by Mullick A, Wright A, Watmore-Eve J and Flatley M, published in the March/April 2013 issue of the European Journal of Palliative Care (vol. 20, no. 2).
• If you already have a web-based subscription to the EJPC you will be able to download and print this issue, plus all articles in the EJPC archive. Members of the EAPC receive discounted subscription rates to the EJPC – click here to subscribe online.

Follow the blog later this week to read Jenny Watmore-Eve’s post on what happens when Schwartz Center Rounds come to St Joseph’s Hospice in East London, the first UK hospice to introduce the Rounds.