As we go about our busy lives, responding to people at their most vulnerable and dealing with the complexity of ever-shifting organisations, do we stop to notice HOW these experiences are impacting on us?
In the 1950s general practice was pervaded by low morale and a poor sense of professional identity. A Hungarian psychoanalyst became intrigued by the unique and powerful setting of a GP consultation and initiated a study with a group of GPs.
Thus Balint groups were formed, which usually involve a group of GPs considering what is going on ‘under the surface’ in a challenging doctor-patient relationship, in order to find new ways of viewing and approaching that patient’s care. The Balint Society publishes a journal, runs an annual conference, and can help you find a local group.
The Point of Care Foundation - a charity ‘with a mission to humanise healthcare’ – helps organisations establish multidisciplinary reflective spaces in which healthcare staff share stories from their work.
The charity supports organisations to introduce ‘Schwartz Rounds’, which provide an opportunity for staff from all disciplines to reflect on the emotional aspects of their work.
What are Schwartz Rounds?
In a typical Schwartz Round a panel of four speakers share their stories, focusing on the emotional impact of the experience discussed, rather than the clinical details. A trained facilitator will work with the panel members to help them craft the story, ensuring it conveys the key points in a way the panel member is comfortable with.
Audience participants can actively contribute to the discussion if there are points of resonance for them, or quietly reflect.
The dispersed organisational structure of primary care brings its own challenges, but Islington CCG in north London has been a frontrunner in setting up Schwartz Rounds in primary care.
Local GP Dr Rini Paul is an advocate of the need for sharing the emotional and social aspects of our work in order to sustain ourselves in the stressful work we do. She, her co-lead Dr Rachel Hopkins and the rest of the steering group find and prepare speakers, and organise the Schwartz Round.
They have often had full attendance at their rounds, with participants from primary care, social care and the voluntary sector - social workers, health care assistants, nurses, doctors and psychologists coming to share experiences and reflection.
How does this help?
The feedback her team has gathered highlights how valuable it is to share stories with a multidisciplinary group of health and social care professionals. It helps us to recognise the commonality in our human responses to working with people in distress and need. Many come away inspired and reignited in their passion to do their work well.
Dr Paul has produced a graphic showing how the Schwartz Rounds work and highlighting some of the feedback they've received, which you can view via the link at the end of this article.
Islington Community Education Provider Network (CEPN) has funded and supported the rounds. It sees this as a good way of protecting and promoting staff mental health, especially in such pressured times.
It is likely that the rounds will have a knock-on effect of enabling better inter-organisational collaboration as attendees gain greater insights into the work and challenges each other faces, and recognise how similar many aspects of their work are.
Dr Paul highlights how important it has been to have senior managerial support the protected time taken, and to see the rounds as a part of continuing professional development. Her team found it very helpful to have senior clinicians presenting poignant stories, revealing their vulnerabilities and uncertainties, thus enabling a culture of openness.
Rhiannon Barker, head of business development at the Point of Care Foundation, says: ‘Creating an open space in which difficult experiences are shared and contained signals that staff are valued, and performing a valuable, challenging role’.
Other options
An alternative, less time-intensive model is now being rolled out by the Point of Care Foundation – Team Time. This is a structured 15-minutes-a-week, in which trained facilitators support a discussion about a challenging work experience.
There is a forthcoming training for Team Time facilitators on 28 July, so sign up if you are interested in helping your team create a supportive space for thought. More information can be found here.
Dr Jennifer Napier is a GP with special interest in occupational medicine. She has researched wellbeing and workforce issues, and works through Contextualyse to train and consult on how to create healthy, productive workplaces.
