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Case Study: Cheshire and Merseyside system level Schwartz Rounds

The pandemic caused high levels of burnout and staff absence at Cheshire and Merseyside Health and Care Partnership (C&M). C&M is an Integrated Care System, which operates across a regional footprint and brings NHS trusts together with other public sector bodies and local charities and voluntary groups into a single organisational structure. C&M sought a compassionate approach to tackle some of the problems it faced in line with the People Plan. As part of the restorative work to support the health and wellbeing of the people who have worked across their partnership organisations during the pandemic, C&M worked with the Point of Care Foundation to set up Schwartz Rounds at a system level. Each of the nine Places in C&M were offered support to train and develop their own steering groups to run Rounds at their Place. In total, six Places were able to set up steering groups and 61 facilitators were trained to facilitate Rounds.

How was the work developed and implemented?

This work was led by Lisa Gresty (Talent, Leadership and OD Lead for the Healthcare Partnership) after receiving funding as part of the restorative work to support the health and wellbeing of the workforce in C&M. The Cheshire and Merseyside Health and Care Partnership worked in collaboration with the Point of Care Foundation to train and support several steering groups at Place level. The aim was to foster relationships amongst colleagues at Places, rather than keeping Rounds accessible to staff from one organisation only. Each Place, steered by a Place lead, was offered a total of 10 facilitator training places and steering group member places (paid for by the Partnership). For Rounds to be effective, a monthly time commitment was needed from all steering group members to plan and prepare for the Rounds. The Point of Care Foundation provided each Place with a license to practice and a mentor to support the early implementation of the Rounds. The Partnership has created a ‘Cheshire and Merseyside Community of Practice’ to share the learning from the different Place steering groups that have begun to start conducting Rounds, and to share the challenges that working as a system with multiple organisations and stakeholders inevitably brings.

Challenges

The main challenge for such a large project was the mindset shift required from those involved – from thinking organisationally to considering the Rounds at a system level. Similarly, the steering groups comprise of a variety of organisations (some non-NHS) which makes organising diaries and commitments more difficult – especially as new relationships had to be established with members who had not always worked regularly with others in the system prior to the Rounds. One administrative challenge was ensuring that facilitators attended all the required training sessions, and completed some e-learning, whilst their business continued as usual and COVID-19 pressures were consuming staff time. This was handled by working in close partnership with the Point of Care Foundation and retaining flexibility in terms of dates and attendees being able to change cohorts. The shared vision was a huge enabler, as well as the passion from colleagues who had previously seen the powerful impact of Schwartz Rounds and benefitted from the experience. There was also an awareness of how system level work could have a large impact across the C&M patch and this attitude was seen in the most successful steering groups.

Key outcomes and impact

Six steering groups were set up at Place level and are beginning to plan and facilitate Rounds to their system colleagues. Warrington and Halton steering group have completed their first Round –  ‘The Long, Winding road- what do the last 18 months mean to me’ –  and received fantastic feedback. 24 staff attended the Round from primary care, secondary care and the voluntary sector. All agreed that the stories presented by the panel were relevant to their work and that they have a better understanding of how their colleagues feel. 80% agreed or strongly agreed that they have gained insight into the roles of others within the wider care system, fostering understanding relationships. 100% of respondents agreed that they would attend another Round and recommend them to their colleagues.

Dr Andy Davies (Clinical Chief Officer) remarked:

The attendees engaged compassionately with the subject and the deeply emotional stories too. The common humanity on display was both humbling and uplifting. There was a great sense of belonging and connection at the end of the meeting. What a great start! A credit to our facilitators, steering group, attendees and of course the brave storytellers who went first.”

Several other Places have now also run their first Round and all have been successful and impactful for attendees.

Lesson learned and final thoughts:

  • Start by ensuring all Place Leads and stakeholders understand the vision, commitment, and adopt a system mindset to implementing Schwartz Rounds at an ICS level.
  • Work closely with the Point of Care Foundation Schwartz mentors to consider any issues or areas of misunderstanding that come from participants of the training.
  • Ensure that colleagues in each Place steering group are aware of the other members of their steering group and are supported in planning, advertising and delivering their Rounds.
  • Consider the aims of the project and use them to inform evaluation methodology to demonstrate value, e.g., how can you measure the types of Organisations getting involved to ensure system buy-in? How can you measure the levels of compassion and understanding for colleagues across the system over time as more Rounds are conducted?
  • Don’t let organisational level thinking dominate – ensure that stakeholders understand the system approach in running the Rounds.

Whilst the Rounds are in the early stages of implementation in C&M, it is confidently expected that they will help to foster compassionate cultures across the system, flatten hierarchies, support staff wellbeing and foster system relationships. The increased collaboration and understanding for colleagues in different roles have been shown to improve the care that patients receive. The Partnership plan to collect evaluation data regarding both the experience of those who attended the Rounds and those on the panel and steering group of each Place at 6-month intervals.