schwartz centre rounds

1©The Point of Care Foundation

Schwartz Centre Rounds


Structure of talk

①What is the problem?

②What is the effect of the problem?

③What can help?

④What is a Schwartz Round?

⑤Impact of Schwartz Rounds

⑥Implementing Schwartz Rounds



At the extreme end

What is the problem?


What is the problem?


Unreliable quality of care

•Evidence from recent public inquiries demonstrate that whilst there are pockets of excellent care, it can be highly variable and inconsistent

•The Francis Inquiry (2013) into failings at Mid Staffordshire NHS Trust provoked calls for the organisational culture of the NHS to become focussed on ‘improving care and putting patients' needs first’ rather than ‘meeting externally imposed standards and targets’

•There is an almost universal desire to provide best quality care but despite pockets of excellence there is considerable inconsistency1

1. Dixon-Woods et al mixed methods study published in BMJ Sept 2013 report


What is the problem? (continued)


A demanding healthcare environment

•Increase in demand and activity

•NHS funding constraints

•Patient population – older, more frail and complex

•Rapid increase in staff numbers; though recent reductions in some disciplines and roles

•Uncertainty at all levels / high rates of organisational change

•Short term relationships – between staff and between staff and patients

•Pressure to reduce lengths of stay

•Care staff working very long shifts


What is the problem? (continued)

Pressures on staff wellbeing oIn 2013 1.7 million people went to work for the NHS and three million patients were treated every week

The 2012 NHS Staff Survey tells us that:

•38% of staff felt unwell as a result of work-related stress in the previous year•69% say they attended work in the previous three months despite not feeling well•30% say they experienced bullying, harassment and abuse from patients, their relatives or the public in the previous year



What is the effect of the problem?


• Withdrawal for emotional protection

• Isolation, depression and stress

• Large minority = burnout

• Lowered sense of personal effectiveness

• Emotional exhaustion

• Depersonalisation of care

“Kindness suffers as the capacity for fellow feeling

recedes.”

Ref: Ballat J and Campling P (2011) Intelligent Kindness


What is the effect of the problem? (continued)


Links between staff and patient experience

There is increasing evidence drawing links between staff and

patient

Experience:

•A study of nurses conducted over three years by Jill Maben et

al (2010), King’s College London, found strong links between

staff well being, staff reported patient care performance and

patient-reported patient experience

•A study (Raleigh VS et al, 2009) analysing data across 166

NHS trusts found that positive staff experience was broadly

reflective of positive patient experience

9©The Point of Care Foundation Schwartz Centre Rounds

“The health professional does a job, and for many people this job is pretty mundane. They’re doing the same kind of thing to the same kind of people pretty well every day. So for them that activity becomes completely routine. And in some cases rather dull.

For the individual patient it’s anything but that. Every individual that comes through a hospital is apprehensive. It’s a strange place, you lie in a strange bed, you have strange sheets, you have odd tea in a plastic cup. The whole thing is vibrantly different.”

http://www.youtube.com/watch?v=--uMNY55nw4

“Mesothelioma: A patient’s journey” Sweeney, Toy and Cornwell: BMJ 2009

What is the effect of the problem? Continued

Dr Kieran Sweeney GP, academic, patient


What helps?


In 2013, the Prime Minister asked Professor Sir Bruce Keogh to review the quality of care and treatment provided by NHS organisations that were persistent outliers on mortality rates. He concluded:

“All NHS organisations will understand the positive impact that happy and engaged staff have on patient outcomes, including mortality rates, and will be making this a key part of their quality improvement strategy.”

Keogh Review (2013)


What helps? (Continued)


The role of leadership

“There is strong evidence that leaders who engage staff, patients and others deliver better results on a range of measures. The business case for leadership and engagement for improvement is compelling at a time when the NHS needs to deliver unprecedented efficiency savings over many years.”

The King’s Fund (2012)


What helps? (Continued)


Effective interventions

1.Does it directly reflect or is it compatible with a systems perspective?

2.Is it described in enough practical detail to replicate elsewhere?

3.Is it flexible, can it be adapted to different environments?

4.Has it been sustained or spread beyond the place where it originated?

5.Has it been subject to an external process of assessment or evaluation?

Source: Adapted from Greenhalgh et al 2004. Goodrich J, Cornwell J 2008 Seeing the Person in the Patient King’s Fund.


Organisations running Rounds by type (Oct ‘14)



Schwartz Rounds

Mentioned in the Francis Report as being something that

can improve team building

NHS England Business Plan published in March 2014

mentioned Schwartz Rounds as evidence based initiative to

improve patient experience

Now running in over 80 healthcare organisations across the

UK


What is a Schwartz Round?


Format of a Schwartz Round

•Lunch is offered before the start

•Presenting team talk for 10-15 minutes

•Trained facilitators moderate the discussion

•The audience is asked to share their thoughts, ask questions, offer similar experiences

•Round lasts for 1 hour in total

•http://www.youtube.com/watch?feature=player_embedded&v=JUk-mIGZm7s


What is a Schwartz Round? (Continued)


Examples of Round themes

•Trying to help in impossible circumstances•Conflict – with patient; family; colleagues•‘Unrewarding patients’ – nasty; terrifying; intractable problems; ungrateful; uncooperative; families•Rewarding patients and the perils associated with them•Organisational events – e.g. poor CQC report, a major complaint; litigation•Human too – personal and professional overlap •The patient I’ll never forget


What is a Schwartz Round? (Continued)


The people involved

•Facilitator (minimum time commitment 1day/month)

•Clinical lead (minimum time commitment half day/month)

•Administrator (minimum time commitment 1day/month)

•Steering group (time commitment half day/month)

•Finances to pay for support and commitment to provide necessary internal resources


Impact of Schwartz Rounds


US evaluations show that Rounds have a positive effect

•For individuals

•For teams

•For organisations

•This impact increases over time spent attending Rounds

Sanghavi DM (2006) What makes a compassionate patient-caregiver relationship? Joint Commission Journal on Quality and Patient Safety 32(5): 283-292.

Lown, BA, Manning, CF (2010) The Schwartz Center Rounds: Evaluation of an interdisciplinary approach to enhancing patient-centred communication, teamwork and provider support. Academic Medicine 85(6).


Impact of Schwartz Rounds (Continued)


In the UK, Round led to an increase in:

•Staff confidence in handling sensitive issues

•Beliefs in the importance of empathy

•Actual empathy with patients as people

•Confidence in handling non-clinical aspects of care

•Openness to expressing thoughts, questions and feelings about

Goodrich, Joanna ‘Supporting hospital staff to provide compassionate care: Do Schwartz Centre Rounds work in English hospitals?’JR Soc Med 2012: 105:117-122

A number of other published studies report positive results




Feedback from Rounds

•Rounds acknowledge feelings and reduce stress

•Rounds encourage networking and multidisciplinary team working

•Rounds contribute positively to hospital culture

•Power of hearing senior staff express vulnerability

•Shared understanding of experience

•Different opportunity to think when not trying to problem solve




What did participants say?

INSERT FROM CHOICE OF QUOTES BELOW


Implementing Rounds in non-acute settings

• Currently (2014/15) researching roll out into

community and mental health settings

• More complex logistic issues; venue and

travel

• As yet no Rounds running which were

primarily set up in primary care

• Advice is to embed in one place and spread

gradually across the patch


Implementing Schwartz Rounds


• Read the website www.pointofcarefoundation.org.uk and ask for an information pack to be sent

• Watch the videos about Rounds on the website

• Contact The Point of Care Foundation who will arrange for you to observe a Round

• Identify a facilitator, clinical lead and administrator

• Identify members of the Steering Group

• Get board support to sign contract and pay for support from The Point of Care Foundation

• Attend training

Note: only organisations supported by The Point of Care Foundation are authorised to run Schwartz Rounds.


Contact details

Esther FlanaganProgramme Manager

[email protected]

Joanna GoodrichResearch and Development Manager

[email protected]

Rhiannon BarkerProgramme Manager

[email protected]


The Point of Care Foundation

11-13 Cavendish Square, London W1G0AN

[email protected]

www.pointofcarefoundation.org.uk


Cancer services


• 2010/11 National Cancer Patient Experience (CPES) survey results indicate that cancer inpatients report significantly better experience of care than do hospital inpatients

• The most significant increase in positive scores relation to information and communication

• A new overarching question asking patients to rate their overall care came out very high, with 88% of patients rating their care ‘excellent’ or ‘very good’. Results.

• However significant variation in this between trusts – 94% in the highest trust to 64% in the lowest.

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