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Surgeons Scope Magazine - July 2022
It’s My Round
WITH EVIDENCE POINTING TO IMPROVED WELLBEING AND RELATIONSHIPS WITH COLLEAGUES, AND WITH MORE EMPATHIC AND COMPASSIONATE PATIENT CARE, SCHWARTZ ROUNDS ARE A KEY STEP IN ACKNOWLEDGING THE EMOTIONAL IMPACT OF WORKING IN HEALTHCARE
Schwartz Rounds
Schwartz Center Rounds, frequently abbreviated to Rounds, offer a safe, reflective space for staff to share stories with their peers about their work and its impact on them. In 2015, the HSE collaborated with the UK Point of Care Foundation to secure a national license to roll out Schwartz Rounds in hospitals and healthcare organisations throughout the country. These organisation-wide forums, which are open to all staff (clinical and non-clinical) to consider emotional, social or ethical challenges through sharing, in a safe environment, their experiences of caring for patients and families, are intended to help improve staff wellbeing, effectiveness of communication and engagement, and, ultimately, patient care. They are unique in that, unlike other supports for staff, they do not seek to solve problems or look for outcomes.
Attendance at Schwartz Rounds is associated with a statistically significant improvement in staff psychological wellbeing. Reported outcomes included increased empathy and compassion for patients and colleagues and positive changes in practice.
Schwartz Center Rounds® (or Rounds), were developed by the Schwartz Center for Compassionate Healthcare, in Boston USA in 1995. They are named after Kenneth Schwartz, a patient in whose memory the Schwartz Center for Compassionate Healthcare (a non-profit organisation) was established and are widely adopted in the USA and in the UK. In Ireland, the HSE conducted its own test of concept in University Hospital Galway and the Our Lady’s Hospice and Care Centre at Blackrock and commissioned an independent evaluation with Trinity College Dublin. Recommendations from this and international studies have informed the practice of Schwartz Rounds here. A memo of understanding has been agreed with 26 healthcare organisations around the country and the HSE is committed to rolling it out to many more. They are keen to hear from surgeons interested in the introduction of Rounds within their organisation.
Dr Maureen Flynn
Dr Maureen Flynn
According to Dr Maureen Flynn, Director of Nursing, HSE Quality and Patient Safety Directorate, QPS Connect Team Lead, the protocols developed in Schwartz Rounds are carefully constructed for participants as a source of support. They are designed as an opportunity to reflect and, with peer sharing, to normalise the emotional impacts of providing care. “Everyone is invited, food is provided – it is about caring for the whole person,” she says. “Once the doors have closed, it’s a private, supportive space and an opportunity for participants to appreciate more about their colleagues, understand their perspectives and motivations and engage in multidisciplinary peer reflection.”
Dr Flynn explains that among the motivations to be involved include coming together around a theme (a joyous or difficult situation) or wanting others to learn from their experience. “Panel preparation is important in shaping the stories and helping panellists feel ‘safe’ to tell their story. The facilitator’s role is important in providing support, guiding the audience conversation sparked by listening to the panellists stories and ensuring that the experience feels safe.”
Ms Aisling Hogan, FRCSI
Almost three years ago, colorectal surgeon Ms Aisling Hogan FRCSI was approached to be a panellist on a Schwartz Round at Galway University Hospital. In terms of experiences in a hospital setting, she remembers it felt entirely foreign: “It was at odds with what we are trained to do and in stark contrast to our everyday life. But, it was extremely powerful,” she says. “Perhaps the most extraordinary aspect was the flattening of the hierarchy. Everyone listened, no one’s story was worth more than anyone else’s.”
She still recalls the very special atmosphere created during the Schwartz Round: “There was a deeply respectful, almost spiritual feeling in the room.” It has had a lasting impact. “People all over the hospital nod and wave at me, people who I don’t normally encounter in the course of my work but who learned that day that I am, like them, just human with all the flaws, doubts and feelings we all share.”
Ms Hogan recognises it may be more challenging to get surgeons involved than other disciplines. “It’s the nature of our job, the life-changing conversations we have daily, the immediacy and gravity of decisions that have to be made all the time that require surgeons to maintain a certain distance and to appear tough. It doesn’t come naturally to surgeons to open up to a wider audience or to invite feelings of vulnerability,“ she says.
“As surgeons, we have our own ways of protecting ourselves,” continues Ms Hogan. “We are very close colleagues, a tight-knit group, so when a safety valve is needed, our colleagues are there. It is our names over the patients’ beds; our patients need to believe that we are confident, totally in control – it’s not helpful for a patient to believe their surgeon has doubts or feelings of uncertainty.”
Are female surgeons even more wary of demonstrating their softer, perhaps more vulnerable side? “Yes, this is particularly pertinent for female surgeons who are in the vast minority of surgeons,” says Ms Hogan.
The break from the mania of hospital life provided by the Schwartz Round was in itself enlightening. “The CEO of the hospital was there, the cleaners and porters, the doctors and nurses. Thanks to the skill of the facilitators, all differences evaporated in the room. The focus was on understanding, learning and empathising,” says Ms Hogan.
Professor Eva Doherty, Director of Human Factors in Patient Safety at RCSI
From an RCSI perspective, the concept of multidisciplinary “rounds” or gatherings that provide emotional support for surgeons has long been of particular interest to Professor Eva Doherty, Director of Human Factors in Patient Safety at RCSI. “Rounds provide a forum for healthcare staff to come together to explore the non-clinical aspects of caring for patients – the psychological, social and emotional challenges. They are a highly structured facilitated space where a panel of staff speak openly about personal experiences of vulnerability and doubt, loss and fear, as well as joy and pride in their role and work,” says Professor Doherty.
“Schwartz Rounds are an effective way of breaking down hierarchies and barriers,” says Dr Flynn. “The principal aim is emotional support – the acknowledgment that there is an emotional burden carried by workers in all aspects of healthcare, and in all disciplines, from the cleaner, the financial controller, the porter, the ambulance driver to nurses, doctors and surgeons, is very powerful. Nobody is immune to feeling that emotional impact from their work, and everyone benefits from support from their peers.”
For Rounds to succeed, stories must be selected wisely to reflect both individual experiences and universal themes. A Schwartz Round steering group oversees and guides the identification of the theme for each Round. The confidential structured space, created by Schwartz Rounds, showcases the complexity of being a surgeon in high-pressured healthcare systems today and promotes a shared understanding that everyone struggles and that while working in healthcare is rich and meaningful, it requires containment and self-compassion to survive and sustain oneself over time.
A GUIDE TO SCHWARTZ ROUNDS
SCHWARTZ ROUNDS: Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to deliver compassionate care by helping them to reflect on their work.
ROUNDS CLINICAL LEAD: Typically a senior doctor or nurse, an individual who works closely with the facilitator and undertakes a skilled co-facilitation role (responsibilities include helping to find cases/panellists, cofacilitation and championing Rounds).
ROUNDS FACILITATOR: A person responsible for leading and coordinating the preparation and conduct of Rounds (responsibilities include panel preparation, ensuring safety and confidentiality, opening up reflective discussion, ensuring Rounds fidelity, and managing challenges and uncertainty).
ROUNDS ADMINISTRATOR: A person who works closely with the facilitator, clinical lead and steering group to enable the efficient running of rounds. For example, booking rooms and organising lunch, promoting the Rounds, co-ordinating steering group meetings, getting the paperwork ready for each Round, sign-in sheets, confidentiality agreement, feedback etc.
SCHWARTZ-SAVVY: A term referring to Rounds attenders who really understand the purpose of Rounds, know and follow the explicit and implicit rules of how to contribute appropriately, and support each other in a non-judgemental way.
ROUNDS MENTOR: A person experienced in Rounds (usually a facilitator) who supports new facilitators, clinical leads and steering groups in the development and consolidation of the skills required to run high-quality Rounds (e.g. by observing/debriefing, and providing off-site support via e-mail and telephone).
ROUNDS STEERING GROUP: A group comprising staff from varied clinical and non-clinical disciplines and representing different levels of seniority (e.g. board members, junior nurses/doctors, porters, human resources managers, and marketing/communication professionals). Responsibilities include raising the profile of Rounds, sharing ownership, helping to find cases/panellists, supporting the clinical lead and facilitator, and debriefing Rounds).
FURTHER INFORMATION
• Surgeons interested in how their own organisations can become involved in Schwartz Rounds should contact Caroline Lennon Nally, HSE Schwartz Rounds Coordinator, caroline.lennonnally@hse.ie.
• Further information on the HSE National Quality and Patient Safety Directorate Schwartz Rounds programme can be found at www.hse.ie/eng/ about/who/nqpsd/qps-connect/schwartz-rounds/schwartz-rounds.html. ■
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