Reflecting on a year (and a bit) in the world of Schwartz Rounds

David Jones 22 December 2022

David reflects on his time with the Point of Care Foundation.

I am writing this as I enter my final weeks at the Point of Care Foundation and find myself flipping between sadness for the things that are ending, and gratitude for all I’ve experienced over the last year. It has been a challenging year in many ways as we’ve worked to rebuild after the pandemic and meet the high level of need for our work. But I have been constantly encouraged by the commitment of the wide range of people who are involved in the Schwartz Community and our patient experience focused work.

My role has largely centred on Schwartz Rounds and the community that makes them happen. When I was asked to write this, the question was, “can you tell us what you have learned in your time with the Foundation?” That is too big a call for a short blog – I have learned an extraordinary amount, some of which is about the health and care system, some about new sectors (to me), a lot about the immense commitment of those who care for their colleagues and a lot about myself.

In all of it, I have met the most wonderful people – full of compassion and commitment to those they work with and the people they care for. Most of the effort involved is discretionary – people putting in work beyond their role to hold space for colleagues – and it has been a beautiful thing to be around.

There have been big highlights for me:

Working with, and learning from, the team at the Foundation to develop the ways we support the Schwartz Community and get access to reflective space for more of the people who can benefit from it.
Finding partnership with like-minded people all over the health and care system holding a radical commitment to kindness, compassion and humanity.
The rapid expansion of Schwartz Rounds in higher education institutions following the Schwartz North conference in March 2022.

And some questions remain

There have been, too, many little, personal highlights, all of which have come in the connection with the people I’ve met who care. They will stay with me for a long time.

There have also been real tensions to wrestle with. We have felt the growing momentum for improved staff wellbeing in the health and care system as organisations have responded to the feelings of hurt and exhaustion that are so common following the worst of the pandemic. This has created new demand for Schwartz Rounds in new places but, sometimes, increased demand creates unhelpful dynamics with regard to organisations’ drivers for running them. For example, they can become seen as an intervention to reduce staff attrition.

Another key question is: Do we stick hard to the Schwartz Rounds principles or flex them to get Rounds to as many people as possible? The same questions arises when we consider whether to run Rounds face-to-face vs online. There is ongoing debate. And, for me, the answer lies in what is important. Is it to give the people that attend the full depth of the Schwartz Round experience? Or is it to give some reflective space to as many people as possible, paying attention to people that are marginalised because of who they are or the job they do?

There are no binary answers here and there are people who are finding satisfactory ways to deliver within these tensions. It will continue to need attention.

Advice for the future

If I can be cheeky enough to offer advice to my successor, I will say two things.

First, there is a major challenge to establish the next phase of data and evidence for Rounds. The evidence base produced by Jill Maben and colleagues is significant in building trust within health organisations who are considering adopting Schwartz Rounds.

There are new and additional questions to be answered now. For example, what works in other sectors? What is ‘good enough’ to make the difference that is required to contribute to humanising health and care? Particularly, how do Schwartz Rounds need to adapt to be relevant to care home staff, to domiciliary care workers and all the other places where people could benefit from reflective space and emotional connection?

The second is about scale – there are many places where space to reflect is (and often always has been) entirely absent. We are seeing the effects of unrelenting system pressure combined with the sense that health and care organisations are poor places to work for many people in the shocking numbers leaving the services. The are many things to be addressed if that is to change but we hear consistently that having some space to reflect and connect with others is a necessary (if not sufficient) component of keeping going.

Final thoughts

More than anything I am struck by how much Schwartz Rounds are true acts of care from the people who organise and run them for the people they work with. I am immensely grateful to have spent just over a year as part of it all and I will remain an advocate wherever I go. I am increasingly finding that poets express the complexity of this stuff better than I can. So here is a poem that captures the gratitude I feel:

AS IF TO DEMONSTRATE AN ECLIPSE
by Billy Collins

I pick an orange from a wicker basket
and place it on the table
to represent the sun.
Then down at the other end
a blue and white marble
becomes the earth
and nearby I lay the little moon of an aspirin.

I get a glass from a cabinet,
open a bottle of wine,
then I sit in a ladder-back chair,
a benevolent god presiding
over a miniature creation myth,

and I begin to sing
a homemade canticle of thanks
for this perfect little arrangement,
for not making the earth too hot or cold
not making it spin too fast or slow

so that the grove of orange trees
and the owl become possible,
not to mention the rolling wave,
the play of clouds, geese in flight,
and the Z of lightning on a dark lake.

Then I fill my glass again
and give thanks for the trout,
the oak, and the yellow feather,

singing the room full of shadows,
as sun and earth and moon
circle one another in their impeccable orbits
and I get more and more cockeyed with gratitude.