Islington CCG in north London and Islington Community Education Provider Network (CEPN) were the first in the UK to deliver Schwartz Rounds to community and primary care staff. While there are now around 200 trusts across the UK that run Schwartz Rounds these are predominantly hospitals, mental health trusts and hospices.
What is a Schwartz Round?
Schwartz Rounds are monthly, multidisciplinary, one-hour meetings with a specific format. Meetings are opened by a clinical lead/champion – in Islington it is a GP.
Next four panelists tell a five-minute story on a given theme or about a patient they cared for focusing on the emotional, ethical and social aspects of the case. The panelists receive support to prepare from the Schwartz facilitator, which in our area is a psychologist, or the clinical lead. The audience listens to these stories and is then invited by the facilitator to discuss their own reflections based on the stories and what arises for them.
As one of our participants has said: ‘Sometimes as community practitioners we can feel isolated due to the nature of our roles. Having an opportunity to share experience reminds us that we are not alone.’
Why did we set up community Schwartz Rounds?
GPs and community staff are facing unsustainable workloads causing increased stress and decreased satisfaction, resulting in recruitment and retention issues. There are increasing pressures, such as managing more patients with complex care needs and a stream of quality performance targets as well as opportunities to try to meet these challenges, including new innovative ways of working.
New research confirms that attending Schwartz Rounds reduces psychological stress, increases compassion and fosters better working relationships for staff.1
Given the current pressures, Islington CCG and CEPN felt all Islington CCG staff (clinical and non-clinical) needed a forum that would support their own emotional health and wellbeing and focus on compassionate care for patients and their colleagues. Our first Islington Integrated Schwartz Round was held in April 2016.
How do you set up Schwartz Rounds?
All those who run Schwartz Rounds in the UK must hold a license with the Point of Care Foundation, which provides training (a one day course) for the clinical leads and facilitators. We also observed other Rounds and were appointed a mentor from the Point of Care Foundation for our first year.
We have a steering group who support and champion the Rounds and help find panelists. We also have a dedicated Schwartz administrator. The facilitator, clinical leads and administrator roles are remunerated within our trust.
Who was invited and how?
Our steering group members and Schwartz administrator are vital to our successes. We wanted to ensure we had a broad spectrum of members from social and voluntary care, community mental health services, general practice, pharmacy, nursing, the CCG and CEPN on the steering group. We periodically invite other members of staff to support us with ideas for themes and panelists.
We target all these groups via internal communications to invite staff to the rounds, particularly inviting senior figures and managers to be panelists in the early days to demonstrate support and encourage attendance. We distributed information and flyers in all relevant bulletins, staff intranets etc. and set up an Eventbrite link when the demand started to exceed our capacity at the venues. We booked local CCG venues and rotated between several sites.
As with all Schwartz Rounds, seeing to people's basic needs is crucial and so we offer food before the Round begins. Our rounds began monthly on Thursdays from 2-3pm with lunch from 1.30pm, hoping that the district nurses and GPs would be able to attend after their morning surgeries, meetings and visits. We always start and finish promptly and encourage the audience to fill in their evaluation and come forward with ideas for future Rounds and volunteer to be panelists.
Over the past 20 months we have had between 19-69 attendees. The average number of attendees has been 28. Our evaluation suggests staff who attend the rounds gain a much better understanding of other peoples’ roles and insights into caring for patients. It makes staff feel we’re all in this together regardless of our individual roles and is a real leveler.
Below is some of the feedback we have had from attendees:
- ‘Very touching and interesting to hear how stories can touch someone for a long time.’
- ‘It was really good to know that other health care professionals are experiencing the same feelings and obstacles, which I experience with my work on a daily basis.’
- ‘Really valuable to have a safe space to hear from other professionals about the difficulties that they encounter in their decision making.’
- ‘Today’s stories made me reflect on how I should actually listen to service users to what they are not actually saying - also do my best not to overlook thing/situations.’
- ‘All the stories were relevant it is a privilege to be invited to someone's home as a professional and to think about how we help with carers and families/clients.’
Our biggest groups of attendees are psychologists, nurses, social workers and managers. We have smaller numbers of other healthcare professionals, GPs and non-clinical staff. We have tried to target these groups (particularly with representation as panelists) but not had much success. Our working hypotheses is that those professions that have supervision as part of their training are more likely to be open to attend the Schwartz Rounds and see their value even before they attend their first round.
Some of our most emotive Rounds have been with health and social care professionals describing being on the other side as patients or relatives and talking about going the extra mile with vulnerable children/patients, these prompted very honest empathetic reflections from our audience too. Where else would we get to discuss these issues with such a diverse multidisciplinary group of colleagues without jumping straight to problem solving?
Our major challenge has been finding and prepping enough panelists each month and so often we have had three panelists rather than four and are trialling reducing the frequency of the rounds this year.
If you are thinking about running Schwartz Rounds in primary care:
- Ensure you have long-term senior support and commitment (including financial).
- Speak to the Point of Care Foundation about other similar organisations to your's to find out how they have done things.
- Ensure your panelists and steering group are representative of the groups you want to invite and are committed and enthusiastic.
- Think about your language e.g. patient/client/service user – so as not to inadvertently alienate any groups to begin with.
- Advertise widely and go for it. They just simply work if people can get there and most people who come will keep coming back for more.
Dr Paul is a GP in north London
- Maben J, Taylor C, Dawson J, Leamy M, McCarthy I, Reynolds E, et al. A realist informed mixed methods evaluation of Schwartz Center Rounds® in England. Health Serv Deliv Res 2018; 6 (37)