‘Too hot to handle’: Which topics can be unsafe for Schwartz Rounds?

Laura Golding, Rebecca Myers and Raymond Chadwick 28 May 2025

A key purpose of the role of Schwartz facilitators and steering groups is to facilitate the co-creation of psychological safety of the Schwartz Rounds forum for all participants. But as Laura Golding, Rebecca Myers and Raymond Chadwick observe, sometimes that means saying no to suggestions for themes or questions.

When is a Schwartz Round not a Schwartz Round? What topics are unsuitable for Schwartz Rounds? Should some topics be avoided because they are ‘too hot to handle’? These are questions that all of us involved in facilitating and supporting Schwartz Rounds have had to consider at some stage. It’s a problem that has increased in recent years, as issues of identity politics, geopolitical conflict, organisational changes and ongoing strain within the health and care system have all become significant features in everyday working life. These are topics that, understandably, people want to address. But they are very often not appropriate for Schwartz Rounds.

At the Schwartz community conferences last year, we ran workshops with Schwartz facilitators to explore the challenges associated with seeking to address these topics through Rounds. The workshops were well attended, indicating a clear appetite for space to discuss and reflect on what Schwartz Rounds are for and what are they not for. This question continues to arise periodically at Schwartz Community of Practice sessions. Between us, we have received requests for topics relating to:

self-promotion of an individual or team
advocacy for a political party or faith
a personal vendetta between staff

Other examples we have come across include holding Rounds on very current organisational challenges such as redundancies or the outcomes of external inspections.

So we thought a blog exploring the issue further would be useful.

What are Schwartz Rounds for?

It is worth revisiting the primary intention of Schwartz Rounds: to support and enable healthcare staff to process the emotional impact of their work and its associated social and ethical dilemmas. However, as we reflected at the workshops last year, telling a story can be seen as a political act, and Schwartz Rounds take place within an organisational context and within established power relations. Schwartz Rounds bring staff together and are, therefore, a form of unifying and connecting in the context of workplace challenges. The model enables a containing space within which those attending the Round can be supported to take relational risks and express strong emotions without a call for action or judgement, or to problem solve or address the issues that are raised. It is for these reasons that some topics are unsuitable.

What drives unsuitable questions?

During the workshops, we invited attendees to reflect on their experiences of negotiating Schwartz Rounds topics within their organisations. Having established clear ground rules in relation to confidentiality, we asked attendees to discuss in small groups why staff/senior managers might ask Schwartz leads/facilitators to run a Round on a difficult or unsuitable topic. We then invited feedback including scenarios encountered and examples of how/whether these had been resolved. We asked attendees to consider how it feels as the Schwartz lead or facilitator to receive such requests that are unsuitable and what might be appropriate ways to respond. We also asked them to consider what the feelings and motivations might be for the person making the request.

In the large group discussion, key themes emerged in relation to senior managers’ defence mechanisms as a way of them managing the inevitable anxieties that arise in providing a healthcare service. We heard examples of ways to hear what is being asked for (what underlies the request) and finding alternative ways of meeting this need, rather than trying to run a Round on difficult or unsuitable topics. Collectively we conceptualised this as relational – a dialogue between the requester and the receiver – and, therefore, about how to respond to meet the different party’s needs whilst maintaining the integrity of the Schwartz Round model.

A key message to emerge from the discussions was the importance of facilitators feeling empowered by being trained and entrusted with the model and therefore having the authority to gate-keep Schwartz Rounds topics and processes accordingly. We also talked about the individual organisational context and about timing. For example, it would not be appropriate to agree to a request to run a Schwartz Round on the challenging outcomes of an external review within weeks of the review taking place, but it could be fine to do this 12 months later.

Key pointers

Based on reflections from the conference workshops and in the wider Schwartz Community, we’ve developed these tips for thinking about this issue:

In general, we have found that it is important to be on the alert for any form of hidden agenda in requests for Rounds topics.
Think about what emotions and motivations might lie behind the topic request.
Remember that facilitators are the guardians of the Schwartz Rounds model in their organisations.
Acknowledge the feelings and concerns that underpin the request and seek to understand this before explaining why a Schwartz Round would not be suitable. Where possible, look for alternative ways of meeting the need by, for example, offering alternative forums (e.g. listening events, staff engagement sessions) for structural, organisational concerns.
Identify alternative, more suitable topics that allow for emotional expression but remain within the Schwartz Rounds model (e.g. “What it’s like to care when the system feels broken”).
Reframe the request into a Schwartz Round topic that invites story, not debate.
Seek advice and support from PoCF mentors, PoCF staff, the Schwartz Rounds community via the PoCF’s Community of Practice.

With thanks to everyone who attended the conference workshops.

References

Some theoretical frameworks that help us to understand and conceptualise psychological safety in Rounds:

The Range of Convenience – from Personal Construct Theory:

Fransella, F., Bell, R. & Bannister, D. (2004) A Manual for Repertory Grid Technique, Second Edition John Wiley & Sons Ltd, Chichester.

Power (influence) as a relational dynamic:

French, J. R. P., & Raven, B. (1959). The bases of social power. In D. Cartwright (Ed.), Studies in Social Power.

Hickson, D. J., Hinings, C. R., Lee, C. A., Schneck, R. E., & Pennings, J. M. (1971). A strategic contingencies’ theory of intraorganizational power. Administrative Science Quarterly, 16(2), 216–229.

Learning in Third Spaces:

Hulme, R., Cracknell, D., & Owen, A. (2009). Learning in third spaces: Developing trans‐professional understanding through practitioner enquiry. Educational Action Research, 17(4), 537–550.

Safe Uncertainty:

Mason, B. (1993). Towards positions of safe uncertainty. Human Systems: The Journal of Systemic Consultation & Management, 4(3–4).