Schwartz Center Rounds® Evaluation of the UK pilots

Patient experience

Posted:11 July 2011
Comments 2 comments

Authors

Joanna Goodrich

Publication details

Pages: 10

In 2009 The Point of Care entered into an agreement with the Schwartz Center for Compassionate Healthcare (in Boston, United States) to pilot Schwartz Center Rounds® in the UK.

The Rounds have been held in hospitals in the United States for 14 years and have expanded to more than 225 sites. Rounds provide a forum for staff from a range of disciplines to meet once a month (or every other month) to explore together some of the challenging psychosocial and emotional issues that arise in caring for patients.

This paper draws together three types of evaluation: the feedback from participants after each Round; a pre- and post-pilot survey (first year of Rounds) completed by Rounds participants; and qualitative interviews with key members of staff in both trusts.

Results show that it is clear that the Rounds:

have successfully transferred to England
are firmly established and ongoing, with support from the top of the organisations
have demonstrated a need
are greatly valued by the staff who participate (Rounds were given a mean rating of excellent/exceptional by 70 per cent of all participants).

Comments

I am competing my doctoral study on the emotional landscapes of placement learning for occupational therapy students who go out on placement in health and social care settings. The students' experiences mirror those of other health and social care professionals. They have to negotiate sometimes very emotionally challenging situations without this being acknowledged by most of their colleagues. In one sense it is intriguing to hear how they learn what the rules are about what one can and cannot express about emotional engagements or reactions in different settings - but on the other hand it leaves me with the overriding sense that we should be addressing this aspect of work in the health service right from the very start of someone's training. Including students in these groups or having something similar at universities would be an excellent way to begin to address this.

The Schwartz Rounds seem very similar to Balint groups. In the 1950s Michael Balint set up groups where GPs could discuss patients who were puzzling or troubling, with a focus on the emotional relationship between the patient and the doctor. Since then and particularly more recently there has been an upsurge of interest in this deceptively simple idea. The Royal College of Psychiatrists has endorsed Balint case discussion as a mandatory training for psychiatrists in training. Locally in Newcastle upon Tyne/Gateshead, we have a thriving Balint culture with interest amongst Consultant Psychiatrists as well as GPs and Clinical Psychologists.
My main point is that whatever we call such groups, focusing on the patient-health professional relationship where the emotional impact of distressed patients who often have complex needs is acknowledged, thought about, not denied or pushed away because their distress is unbearable, seems to me essential in a modern day health service, not just a mental health service! Upskilling staff, training and education with hard evidence of certificates and diplomas is very laudable, but has to be built on the foundation of the relationship between professional and patient.
Moreover an organisation that can value reflective practice where
there is an open and transparent culture, is much less likely to end up in severe trouble, obsessed with meeting targets. Whereas Balint groups and Schwartz rounds involve clinicians, such principles can be applied in a wider context to higher management and even Trust Boards.
The Frances enquiry made a number of very important recommendations, but I dont think that it emphasises enough the centrality of human relationships in all their complexity, in providing ordinary good enough compassionate care.