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Getting the whole picture

Craig Gannon and Anne Cullen Princess Alice Hospice 07 October 2014

Princess Alice Hospice in Surrey is in their third year of running Schwartz Rounds. In the true hospice and Schwartz tradition of inter-professional collaboration, medical lead Dr Craig Gannon and psychosocial facilitator Anne Cullen jointly reflect on their experiences of setting up Schwartz Rounds at the hospice.


More than a little sceptical

Craig Gannon: When I first encountered Schwartz Rounds, I was interested in the concept, but more than a little sceptical, thinking they might be just a ‘fashionable’ re-branding of compassionate care, replicating the type of staff support that I believed was already in place in the hospice. But then I had a ‘light-bulb moment’ during my facilitator training, when I realised that there is a unique potential arising from the human perspective of Schwartz Rounds; by allowing us to ‘see the person in the professional’, they parallel the importance of ‘seeing the person in the patient’. The significance of this came home to me when I elected to speak at one of our first Schwartz Rounds. Despite being among supportive colleagues, in the lecture theatre where I’ve spoken many times, I experienced an unanticipated ripple of fear. It was disconcerting to have lost my usual professional or academic ‘shield’ that I used to justify embarking on a monologue. I felt newly exposed, because I was talking about my personal feelings, which would have been routinely filed away under any other circumstances at work. There was a later positivity that came from this cathartic process, and my world didn’t end after I’d revealed that I too had the same insecurities as the panel.

Contributions from a wide range of staff

Anne Cullen: Some of the most memorable Schwartz insights have come from contributions made by members of the housekeeping and maintenance staff, healthcare assistants and volunteers. As so-called professionals, many of us had not appreciated how much they knew, the detail of what their jobs entailed or how they were affected by the things they saw and heard. Presentations by a housekeeper, a healthcare assistant and the hospice’s chaplain offered three radically different responses to hospice weddings: quiet pride in making the occasion special, anger that still burned powerfully more than a decade after watching an almost comatose bride zipped into a tight wedding dress, and a painful awareness of the spectre of death at the wedding.  Each of these presentations elicited resonances from members of the audience, and there was a palpable sense of relief within the room that it had been possible to talk about the ambiguity and ambivalence surrounding such events. The presenters later contributed to a poster that was presented at a palliative care conference. This is a small example of how Schwartz Rounds have helped us to appreciate and develop the potential of people within the organisation.

Challenges and rewards

There are some particular challenges that have emerged in running Schwartz rounds in a small organisation like a hospice. Some staff have said that they feel less confident to ‘expose’ themselves emotionally in front of people whom they see every day than they would have done in a large hospital. But such concerns are more than balanced by the buzz of corridor conversations that follow the Rounds between people who may never have spoken before and by reflections such as the one below:

“I sometimes feel as if you’re a little part of a jigsaw and going to a Schwartz Round you see all the other bits of the jigsaw so you actually get the whole picture which is…….it’s reassuring, it’s comforting, it’s enlightening, it’s educational, it’s all these things”

Do you work at a hospice? What support do you have in place for staff?


This blog has been adapted from Gannon, C., Cullen, A. and Knight, A., “Contrasting Schwartz Rounds with clinical ethics: three perspectives on their potential to impact on end-of-life care”.  Nursing Ethics 2014 21:621. Sage Publications.

Dr Craig Gannon is Medical Director and Anne Cullen is Manager of Psychosocial and Spiritual Care at Princess Alice Hospice, Esher.