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Schwartz Rounds support mental health and community staff to provide compassionate care

Michelle Farr CLAHRC West 24 April 2017

In this blog, Michelle Farr explores the findings from research into the implementation of Schwartz Rounds in mental health and community settings. The blog looks at the benefits of introducing the Rounds, as well as some of the barriers to successful implementation.

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‘Schwartz Rounds’ help mental health staff give more compassionate care, research has found. Schwartz Rounds provide a structured forum where all staff can come together regularly to discuss the emotional and social aspects of working in healthcare. The research found that the Rounds are effective in mental health and community settings.

Schwartz Rounds are spaces where healthcare staff can share their experiences of the emotional and social aspects of healthcare work. These evidence-based discussions can improve teamwork, provide support for staffand support feelings of empathy and compassion toward patients. Developed in acute services, they are now being implemented in various settings including UK community and mental health services. The research study, published in Qualitative Health Research, investigated their implementation in depth in three different community and mental health organisations.

Impact of Schwartz Rounds

The research found that participants appreciated attending Rounds and said that they helped:

  • Staff to be more patient aware, enable more compassionate care and improve communications with patients and be more mindful of the emotional impact of their work
  • Improve trust and openness when relating to colleagues, recognising both shared experiences and different perspectives. Rounds enabled new connections between colleagues from different disciplines, teams and hierarchical levels
  • Enable a more open culture where staff feel valued, and that acknowledges the importance of the emotional aspects of work.Through sharing their emotions about caring experiences, Rounds enabled staff to experience a common humanity and generated feelings of compassion.

Lessons from implementing Rounds in community and mental health services

Two of the organisations studied were successfully running Rounds, but one organisation stopped the Rounds because of implementation and staff attendance challenges. Implementing Rounds was improved by:

  • A dedicated staff group committed to and sharing the workload to implement Rounds
  • Strong leadership with managers at all levels supporting their set-up and attendance
  • Organisational and professional cultures that valued reflective practice and staff support
  • Publicity so staff could see the potential benefits of attending
  • Rounds located near where staff work so they could easily access them
  • Organisations promoting staff support and compassionate care, with Rounds being part of the vision and values of an organisation.

What was it like to participate in a Schwartz Round?

The discussions in Schwartz Rounds could be emotionally powerful. Staff discussed the impact of connecting with patients who may be experiencing distress and suffering, and how to manage their own vulnerabilities and emotions within this. Professionals reflected on how they could connect with patients’ experience of pain and difficulty in a way that did not then lead to burnout or stepping outside of professional boundaries. The different pressures on staff that were discussed included:

  • Pressures such as complaints, reduced beds, service reorganisation and patients’ perceptions of this, consistency of care and managing patients’ expectations of the service
  • Patients’ anger and aggression towards healthcare staff
  • Emotions arising where actions did or did not lead to the relief of patients’ suffering.

Developing new team based forms of reflective practice

Geographical spread of staff and work pressures were challenges in attending Rounds. The Point of Care Foundation, responsible for implementing Schwartz Rounds in the UK, have developed a new team-based reflective practice, called Team Time. Team Time is informed by the findings of this research, which suggested that, alongside Schwartz, a more flexible form of reflective practice targeted at teams was needed. Using a similar model to Schwartz, where trained facilitators use staff stories to evoke discussion about the social and emotional aspects of working in healthcare, Team Time happens weekly and lasts just 15 minutes rather than a full hour. Training and resources for this new model are available from The Point of Care Foundation.

Who was involved in this study?

The research study was a collaboration with the University of Bath and The Point of Care Foundation, and funded by the Department of Health. It was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West).

Read the full research paper

Farr, M. and Barker, R. (2017) Can staff be supported to deliver compassionate care through implementing Schwartz Rounds in community and mental health services? Qualitative Health Research. DOI: 10.1177/1049732317702101

 

This blog was originally published on the CLAHRC West website on 18 April 2017.