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Changing organisational cultures: Evolutionary Schwartz Rounds

I’ll never forget the first time I heard about them: Schwartz Rounds… What on earth is that?

I remember thinking, “oh here we go again, will this be something we spend £1000s on and get nothing out of?” Two years later, I giggle about this because I couldn’t have been more wrong! I have never worked on a project I feel so passionately about in my entire 16 years NHS career.

I joined the NHS because I care and wanted to make a difference to people’s lives. What I did not realise, with my naïve youth, was that I was entering an institution that had a history of teaching clinical staff to be uncompassionate as a way of protecting themselves. This seemed so bizarre to me and it took a long time to recognise what organisational culture was.

Most people know that the NHS was set up to treat those who would otherwise not have been able to access healthcare. This in-and-of itself is an act of compassion and kindness. So how and why could such a well-meaning initiative have so many problems? Well politics aside, some of this is a lot more obvious to identify. When we think about organisational culture, and how it could impact NHS development, we think about people. Science and medicine continue to develop so why are services not meeting people’s needs? Why are positive patient outcomes low? All these questions were answered for me after I attended my first few Schwartz Rounds.

I’d never witnessed professional colleagues be so authentic and it made me feel safe. I realised in that moment that I was not alone and almost every emotion I’d experienced at work was shared by everyone in the room one way or another.”

Learning about Kenneth Schwartz, and reading about his experience of healthcare at his most vulnerable time, was an absolute revelation. Not only this, but attending Schwartz Rounds taught me that the most important thing in life is compassion and empathy. Without compassion or empathy towards each other, it is incredibly hard to be compassionate or empathetic towards our service users. They say, ‘kindness makes the world go round’ and this could not be truer.

Everything we do in life we should do with good intentions. Even if the recipient does not recognise this, we should still do it. We subconsciously teach others to be kind by demonstrating good intentions and compassion and this creates organisational change in attitudes towards each other as people. An organisation with lots of kind people cannot be a bad thing – especially in healthcare. What I also learnt is that it is ok to be vulnerable, it’s ok to be human. We are not robots and we do not need to be, nor are we expected to be invincible.

As much as we all want to be a superhero, the reality is, we all have a breaking point and we can all burnout. So what happens when we hit that point? Well one would imagine that working in healthcare, we would be able to turn to our colleagues, share our difficulties and ask for support – ‘a problem shared, is a problem halved’ right? Unfortunately, this has not always been the case. Sometimes we hide behind our professional armour. Symptoms of being an imposter kick in and we start to treat ourselves with a lack of respect and kindness. Then, depending on organisational culture, this can become toxic and detrimental. For example, it decreases patient satisfaction outcomes, increases staff sickness, and leads to poorer retention rates. Organisational change can take time and, if staff are always off sick or leaving, then it can become even harder and take even longer.

Irrelevant to your role, you are human and you experience the same emotions as everyone else. We are all part of one entity, one NHS. If one person can impact another person, then this chain of impact will eventually affect the entire NHS and, over many years, this is exactly what has happened.

So, now we recognise this as a problem, how can we tackle something so intangible, so large scale? This is where Schwartz Rounds can make a difference. Schwartz Rounds provide the space needed for all staff to come together, to talk and share their experiences of working in healthcare – the highs, and the lows – creating a sense of comradery and a safe space to be vulnerable. It really is that simple, but it’s not so straightforward for organisations. It starts with a willingness to be open and vulnerable, which can be scary for anyone. The first time I was able to be myself and demonstrate authenticity was when I attended my third Schwartz Round and heard colleagues talking about their mental health. I’d never witnessed professional colleagues be so authentic and it made me feel safe. I realised in that moment that I was not alone and almost every emotion I’d experienced at work was shared by everyone in the room one way or another. The sense of isolation dissipated and I suddenly felt like I had a ton of support. I did not need to feel ashamed or guilty – it felt ok to be human.

This has really helped me step out of the cultural norms associated with working in the NHS and, as a senior leader, I am now able to demonstrate my vulnerabilities to my colleagues without fear. It’s this simple act that creates organisational change. Be brave, step out of your comfort zone, think creatively – just because something is the norm, does not mean it’s right. There are many examples throughout history of wrong practice but at no stage did we agree that change was not needed. There were always brave individuals willing to step outside of their comfort zone, and of the cultural norms of the time, to drive change. This is evolution, this is growth!