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Schwartz Rounds in integrated care: supporting quality improvement and aiding integration

Julian Groves 26 February 2020

Julian Groves explores how Schwartz Rounds could help integration in new organisations or partnerships delivering health and social care

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When we ran patient engagement training for ‘Our Dorset’, the new Dorset Integrated Care System, we were thrilled with the impact the work had for the partnership’s capacity to engage with its users. As was evidenced at the celebration day in November, where teams shared their learning, we saw an impressive willingness to be open to the principles of co-design. We also found that different teams and organisations that make up the Our Dorset partnership found there was a good deal of common ground in terms of the challenges they face.  

In the context of a major organisational change like the creation of an Integrated Care System this is striking. Change is unnerving and unsettling. Integrated Care Systems are in place to re-think how care is delivered – which should be good news for patients, but might not automatically seem like good news for staff. In a context of change, jobs can be altered, and the security of knowing where or how someone does their everyday work disappears. It’s a stressful time. If coming together on a transformation project goes some way to supporting people caught up in these change processes, all the better. We are clear that for quality to improve, staff need to feel secure, to feel listened to. So we started to think, what more can we do to support this?

Our answer is Schwartz Rounds. We’ve seen why Schwartz Rounds are so effective in healthcare organisations. What we’ve also seen more recently is the impact they have had in non-healthcare environments. In the last couple of years, Rounds have been taken up in veterinary surgeries, prisons and children’s services (supported by the What Works Centre pilot). These are distinct types of organisation, with distinct workforces, but they have certain traits in common. They all place a significant emotional burden on the people who deliver their services. And (often, but not always) they face many of the same kinds of organisational challenges that NHS staff report – complex systems squeezed by funding pressures, a feeling of being a cog in a machine … a lack of humanity. 

Reason then, to think about whether and how Schwartz Rounds could be applied to the ICS context. Could they be of value to people working within organisations making up Integrated Care Systems? Possibly. After all, why shouldn’t someone working with vulnerable people in local government or the voluntary sector experience similar benefits from Rounds as someone in a health organisation? But what if Schwartz Rounds could be used across an ICS – as a shared resource for all staff to benefit from? 

What the evidence tells us

There is powerful evidence to suggest that this would be effective. In our reporting Jill Maben’s 2018 study on the effectiveness of Schwartz Rounds, we have focused a lot of our attention on the finding that Rounds reduced by half the rate of psychological distress among people who regularly participated, compared with a control group who did not. But a further finding was that Rounds within organisations help to build empathy between colleagues. By revealing hidden staff and patient stories, Schwartz Rounds were found to reduce isolation and improve support and teamwork. 

Because of this impact, Schwartz Rounds are an enabler for quality improvement work. By providing space for colleagues to reflect together and identify common experience, Schwartz Rounds help to change cultures. For organisations to fully embrace patient-centred care, they need to have in place a culture that allows for challenge to the status quo, and for teams delivering services to be open to questions about how they can develop and improve.  

Supporting organisational culture

We see this as part of humanising care – but people delivering services are only human themselves, and it is scary to up-end all that you know in a co-design process, ceding power to service users to inform you, the professional, about how you should improve. The mindset within an organisation – affected by personal feelings of security and safety, and a culture of openness – makes a huge difference to how effective quality improvement can be. In a context of major institutional change, reconfiguration of services and the human impacts these processes have on staff, there is a powerful argument for Schwartz Rounds. 

The growth in capacity for patient-centred quality improvement that we saw in Dorset was inspiring and gives us hope for many other Integrated Care Systems to similarly build services around service users. But underpinning this change was an openness from staff that allowed it to happen. Schwartz Rounds can help organisations to foster this culture and enable similar change. 

Integrated Care Systems: Engaging Patients and the Public