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Making Schwartz Rounds ‘part of the furniture’

Annie Mitchell and Sarah Jackson Royal Devon & Exeter NHS Foundation Trust and Devon Partnership NHS Trust 19 October 2015

In this blog, the facilitators and clinical leads from Royal Devon & Exeter NHS Foundation Trust and Devon Partnership NHS Trust explain how they made Schwartz Rounds ‘part of the furniture’ in their organisations.

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Since Autumn 2013 our joint Schwartz Rounds at Devon Partnership NHS Trust and the Royal Devon and Exeter NHS Foundation Trust have become very successful and very important to our staff. We’ve held 16 Rounds now, and over 1,000 staff have attended.

By holding joint Rounds we hoped they would help build a sense of community and shared endeavour between our two Trusts. We are the only members of the Schwartz Community who, despite being mental health and acute trusts respectively, run Rounds together.

This can sometimes create a few problems, but that’s not to say the effort isn’t worth it. In our latest Round our panellists drew on a case which saw both Trusts working together to help treat a patient with neurologically unexplained symptoms.

The patient’s care required huge resources, patience and collaboration across both trusts. In the Round we heard how, thanks to the persistence and dedication of staff from both trusts – sometimes at huge personal and emotional costs – the patient began to see their quality of life improving. Rounds like this really help build the shared hope, pride and endeavour in our work that we wanted to achieve.

But to be able to make these big collaborative and cultural changes, Rounds needed to become embedded in the working lives of staff. And for the Rounds to become part of the furniture, we needed the tools to build them.

The tools to build the furniture

The first tool isn’t really a tool at all. Think of it as a foundation – Schwartz Rounds need a good circle of fundamental supporters to enable the changes they can bring. But to bring them to the staff regularly and effectively you need to make sure you have all the tools below.

First, you need a dynamic, enthusiastic steering group. Ours includes allied healthcare professionals, doctors, psychologists, managers and a chaplain (we also have, after a long wait, a nurse joining the group). This makes sure that the Rounds remain relevant to all staff.

Second, you need good facilitators. With our trusts working together, it was necessary to have two teams of facilitators – but being able to alternate and split the workload ensured that their work did not become too taxing for either team. The facilitators also need to have good relationships. The long journeys from Devon to London, for the Schwartz Rounds facilitator training, gave our facilitators a chance to really get to know each other’s stories, careers and struggles.

Third, you need committed administration. This is essential, having no organisation means that Rounds can fail before they begin – but done correctly the administrator role can become one of the most rewarding. It might not seem glamorous, but it’s essential to keeping the Rounds going.

Fourth, you need good publicity. If you build it, they will come – but only if they know you built it in the first place. Our communications department has been incredibly supportive in making sure as many staff hear about Schwartz Rounds as possible.

Fifth, you need to get influential members of staff engaged. We’ve been nominated for awards for the teamwork we’ve shown in improving our trusts, and we’ve had a chief executive sitting on our Schwartz Round panel telling us why they came to work! Both events really helped raise the profile of the Rounds.

Finally, you need to make Rounds accessible. We’ve held local Rounds for staff in the community across Devon, and out to professions. This has helped us ensure that all our colleagues were able to access the support Schwartz Rounds can bring.

Part of the furniture

Of course, that’s what you need to do. But have we managed to make Rounds part of the furniture?

Well – yes and no – indeed, our latest challenge is that there might not be room for our furniture at all. The large meeting room we use for Rounds at Devon Partnership has been re-designed for open plan working, to help us use our services more efficiently and effectively but reducing space for collective activities

And, if we are becoming part of the furniture – what piece of furniture are we? A comfy chair? Some bookshelves? That chair in the corner of your bedroom which has become a repository for clothes not yet put away?

We want to be a large round table with space for all to sit shoulder to shoulder and talk about the way we feel coming to, during, and leaving Royal Devon & Exeter and Devon Partnership Trusts.

Of course, the work we do in Schwartz Rounds is often quite at odds with the way the NHS keeps its house, and furniture in order. Targets, bureaucracy, and rising workloads mean that it can be tricky for us to let down our defences, and feel safe to talk freely about shared pre-occupations, loves, shames and humanity.

Reflection and mutual support can never be taken for granted – they require hard emotional and practical labour – just like our regular day-to-day work. We, like so many others working in healthcare, need the nourishment served at the big Schwartz Round table to keep us going through tough times.

Sarah Jackson, Consultant in Healthcare for Older People and Movement disorders, Royal Devon and Exeter NHS Foundation Trust and Schwartz Rounds clinical lead
Annie Mitchell, Clinical Psychologist, Royal Devon and Exeter NHS Foundation Trust and Schwartz Rounds facilitator
Rani Bora, Consultant Psychiatrist, Devon Partnership NHS Trust and Schwartz Rounds clinical lead
Sarah Frazer, Assistant Director of Organisational Development, Devon Partnership NHS Trust and Schwartz Rounds facilitator