A Schwartz Rounds facilitator’s story
04 October 2017
Schwartz Rounds facilitator and trainer Jenny Watmore-Eve reflects on her involvement in Rounds at BHR, highlighting their unique ability to unite people on a human level.
As I wave a fond farewell to my Trust (Barking, Havering and Redbridge University Hospitals NHS Trust), I would like to take this opportunity to say a very heartfelt thank you for giving me the opportunity to introduce and facilitate Schwartz Centre Rounds here. This work has had a profound effect on my career. Since April 2015 I have had the privilege of facilitating 26 Trust-wide rounds and about a dozen “pop-up” Rounds.
This work has allowed me to meet staff from all strata of the organisation, from the porters, ward clerks, nurses and doctors to the executive team and many more in between, all of whom are passionate about their work. They are also aware of the constant balancing act experienced in the NHS between providing compassionate, safe high standards of clinical care with the need to meet targets and work within set time frames with limited resources.
A counter-culture space
In many ways the Rounds are counter-cultural; they have no expected outcomes, they are not driven by policies or procedures, and problem solving is avoided. They provide a safe therapeutic space in which staff can take a brief respite from their busy target-driven working day to slow down; to stop “doing”, and engage in “being”.
I have been struck by people’s willingness to share their stories as panellists, to trust in the process enough to share their vulnerability with their colleagues and tell stories of their everyday working experiences with integrity and openness. I have been humbled by people’s surprise that anyone would want to hear their stories; staff routinely underestimate the emotional impact of their work. By relating their individual experiences, panellists’ stories are witnessed, validated and reflected on by the audience and important human connections are made as staff learn more about their colleagues’ roles, glimpse the people behind the badges. By sharing the weight of emotion it becomes less burdensome and people feel less alone and exposed.
Trust in the process
Schwartz rounds do not happen without careful management and facilitation and a lot of work goes on behind the scenes ahead of each monthly round, without which they would not have the powerful impact they have had. As a facilitator one has to trust in the process and in the unknown, for until the moment when the doors close we don’t know who, or how many people will attend. And although we have a panel and a theme, we can never know where the “community conversation” that follows the panellists’ stories will lead.
The facilitators need to provide safety for the panel and for the audience by ensuring that ground rules are adhered to, by explaining the process carefully, ensuring that problem solving and judgements are avoided, and by making connections and validating comments from the audience that assist the conversation to flow.
Panel preparation is an essential element of the rounds; staff often underestimate the power of telling their story (and at a first practise session are often overcome with emotion) and of being heard without judgement. In the preparation the facilitators’ role is to reposition the story, separating the personal and profession and maintaining an authentic, empathetic curiosity which creates the powerful storytelling which is the essence of a successful round. This represents a different way of talking about the work and often creates some anxiety which the facilitators need to hold, and it is essential that the panellists and the facilitators have heard the stories before the round and will not themselves be overwhelmed by the emotional content.
Something told me that I needed to do this
The rounds can be very emotional; audiences have frequently been moved to tears, for example:
I didn’t really have time to stop and hold his (the patients) hand, but something told me that I needed to do this…such a simple thing. He died that night….I hope I provided some comfort
We are taught not to show our emotions…but it felt so right for me to hug her (the patients mother) and we cried silently together
I will never forget the nurse who held my hand during that procedure.”
The empathy and compassion in the room at such times is palpable. Panellists are respected and there is rapt silence as they speak. Sometimes there has been laughter; when staff describe the use of humour to manage the unrelenting stresses of working in a busy, pressured health-care environment, and the occasional round of impromptu applause from team members and friends supporting their colleagues, and recognising the toll of presenting.
The rounds are a non-hierarchical space in which anyone and everyone has an opportunity to be heard, and, or to witness the stories of their colleagues. They are places where staff can share how their work has affected them;
I went home and cried in the shower
I still remember that child that I cared for as a student many years ago
I felt I had to hold onto my emotion although I felt teary…when we left the room the nurse burst into tears….I comforted her, but cried later watching tv at home”
And also how these very moving and memorable experiences have shaped them, and influenced the care they deliver, or assist others to deliver now.
They are also a space where the complexities of boundaries are explored:
I (a staff member) was a patient on a mental health unit…I didn’t want special treatment
When my Father was dying I was trying to be his physician…I wish I had just allowed myself to be his son
It wasn’t until I brought my Father into the hospital (where I worked) that I could really step into a patient’s shoe and recognise what needed to change
Caring for that family (as a clinician) taught me how to manage my own family trauma… how to behave with dignity whilst in pain.”
And importantly a place where staff can sit in a comfortable silence processing their reactions to the reflections they have witnessed. They are a forum where contributions are received with curiosity, and where every contribution is validated by the facilitators.
Impact of Schwartz Rounds at Barking, Havering and Redbridge University Hospitals NHS Trust
Audience numbers have fluctuated over the months with rounds at Queens attracting between 25–80 people and smaller numbers at King George Hospital. Evaluation forms are always collected and it is obvious that for the vast majority of attendees the experience was a powerful one and a good use of precious time with an average of 80% of respondents rating the experience as excellent or exceptional, with comments such as:
Excellent opportunity to connect with what it means to be whole human beings and health care professionals
Brilliant reflective space, really important in current NHS climate
Really thought provoking and moving”
We took part in a national research programme looking at the cumulative effect of attendance at rounds on the mental wellbeing of staff. At a time when suicide figures for junior doctors are rising and increasing numbers of health care professionals are experiencing mental health difficulties this feels very apt. The research findings will be published in the near future, but there are already indications that the cumulative effect of attending rounds has a positive impact on the mental health of staff.
There are many people who assisted me to bring this magic to BHRUT, people who understood the importance of the rounds in shaping the emotional culture of the Trust, and I thank you all for believing that this could work. A huge thanks to all the panellists (too many to list, but you know who you are, and be assured that I will always remember you).