Engage: Schwartz Centre Rounds and the impact of person-centered care in today’s healthcare

Schwartz Center Rounds® were created from an idea by Kenneth B. Schwartz – who passed away in 1995 from lung cancer, aged 40. A few months before Kenneth B. Schwartz passed away, Schwartz wrote an essay about the feelings of receiving compassionate care and shared this experience suggesting that everyone should be eligible for this kind of care. The Schwartz Center for Compassionate Healthcare in Boston Massachusetts, USA was developed by him a few days before he passed away to support other patients to understand the emotional impact during while receiving care. The vision was also to promote compassion ‘In healthcare and to encourage healthcare workers to make ‘the unbearable bearable’ through ‘the smallest acts of kindness’’ (The Schwartz Center for Compassionate Care, 2018).

Schwartz Center Rounds® started in 1995 in the United States and have since been developed in more than 440 healthcare institutions and organisations in Canada, Australia and New Zealand and provide support for around 200,000 staff members. In the United Kingdom and Ireland the Schwartz Rounds are running in 177 organisations and provide a safe place in which healthcare staff can have discussions on the emotional impact of the care they provide (Quality Improvement Division, 2018; The King Funds, 2018; The Schwartz Center for Compassionate Care, 2018).

Schwartz Rounds are often monthly meetings for multi-professional members of staff working in health care organisations. They usually have a time frame of one hour and are tightly structured. These Rounds support staff and enable them to reflect on the emotional aspects of their daily work. The focus is on feelings around the human element of care. The Rounds will be on pre-planned topics organised by a facilitator and is based on an experience of a patient, keeping their identity confidential. The experience scenario will be briefly presented by a team of 3 or 4 staff members and is followed by a facilitated discussion. The audience is asked to share their thoughts, to listen, ask questions and support (The Point of Care, 2018).

Paul Gilbert OBE is a psychologist from the UK, and is the founder of compassionate focused therapy (CFT) and compassionate mind training (CMT). He stated in his book, ‘The Compassionate Mind`, that compassion is being “sensitive to distress of self and others with a commitment to try to do something about it and prevent it”. Furthermore, he implied that awareness could be developed beyond biological limitations, so that compassion as a non-innate tendency can be chosen to be nurtured in relationships with patients and caregivers. Gilbert explains this well very well in his book and states that an impressive vision can emerge and confidence can grow with caregivers. Gilbert reflects that caring for ourselves and for other people will engage a need to utilize an honest desire that occurs during the caring process when we are stressed and want to promote the wellbeing of others. Gilbert also asserts that when an individual manages to provide compassion towards themselves, the need for more engagement to care for others takes place, as well as being supportive and helping to promote a wellbeing environment towards the self and others (Cole-King &Gilbert, 2011).

Compassion in the caregiver and patient relationship is an essential and vital part; it demands focus on the patients’ needs and full concentration which can be difficult when the working environment is fast paced and pressurised. Compassion itself can be applied within minutes, but it can take time to show compassion on a regular basis towards patients who are, for example, chronically sick or elderly patients. The research into the use of the Rounds, has shown that ‘compassionate care begins with compassionate people’ and patients benefit from compassionate care (Lown, 2014).

To promote a compassionate patient and care giver relationship, it is important to get the right support. As staff member, Dame Black argues in the NHS Health and Wellbeing Review; “There is a compelling case for organizations of all sectors and sizes to move beyond the traditional health and safety agenda to embed health and wellbeing at the heart and to create an empowering and rewarding work environment for all employees” (Dame Black, 2015).

In the latest staff survey report (2015) in England, it was evident that 37% of NHS staff still reported that they experience work related stress and pressure. Literature shows that there is a relationship between the wellbeing of staff and the wellbeing of patients. For example, the Boormann review (2009) states that 80% of staff members in the NHS feel that their health and wellbeing has an effect on patient care; however only 40% feel that their employer would take actions for support (The Health Foundation, 2016).

Jill Maben one of the researchers stated that, “Delivering care to patients at some of the most challenging times in their lives has an emotional impact on staff, which undoubtedly impacts on their own wellbeing and on their work. Our study is the first in the UK to demonstrate that those who regularly attend Rounds see significant benefits; their symptoms of anxiety and depression are reduced, they are better able to cope with the issues they face and have more empathy towards patients and colleagues, which undeniably has a positive impact on those in their care.” (Maben, 2017)

What is unique about the Schwartz Center Rounds® is that, regardless of their profession or specialty, they bring all staff together on an equal footing, to share their stories and experiences, their motivations and the different challenges they face in clinical practice every day. They appear to provide an important space for staff to detail the highs and lows of their work and gain support and insights from colleagues (The Point of Care, 2018).

The report ‘Creating space to reflect: Schwartz Center Rounds ® in action’ was published by the Point of Care Foundation in 2014. This report explains how Rounds are a powerful tool, and details that most of the meetings involve a number of participants ranging from 20 to 120 members. Research shows the Rounds are indeed valuable and do offer benefits for staff wellbeing resulting in a better understanding of the patients’ story which has the potential to ‘effect cultural change’ within nursing care. (Point of Care, 2014)

Apart from sharing experiences, Schwartz Center Rounds® also cultivate an environment that encourages multidisciplinary staff to share their feelings. It helps staff to feel understood and supported; their feelings are reflected and shared by other team members. Schwartz Center Rounds ® also to encourage staff members to achieve better problem solving skills while keeping the patient in the spotlight (Pepper et al., 2012).

A data evaluation from more than 5,000 members in 2015 shows that 85% of staff who attended Schwarz Center Rounds® feel that they are able to provide a more supportive compassionate person-centered care. Additionally it is shown that investments on these Rounds bring benefits to patients, healthcare staff and staff at an organisational level. These benefits include increasing insight and confidence when dealing with emotional aspects and sensitive patient care, and decreasing levels of stress and isolation by staff members. This has led to improving interdisciplinary team communication and teamwork, staff cohesiveness and an openness to express feelings. Organisational benefits can be found through reducing costs in areas such as sickness rates, as staff are more satisfied and reduce patients’ complaints (The Point of Care, 2018).

The Point of Care Foundation, which is the leading source for Schwartz Center Rounds ® in the UK, offers support to all organizations who wish to deliver Schwartz Center Rounds ® in their Health Organisation. The Foundation is the exclusive provider of these Rounds in the UK, which includes training sessions and in house training and support. Additionally the Rounds are accredited by Continuing Professional Development (CPD) in the UK and are regularly evaluated in standard format in legal agreement with the Schwartz Center for compassionate Care (The Point of Care Foundation, 2018).

“The true heroes of our hospitals are not the nurses or the doctors but the patients. Most patients are just ordinary people thrust into extraordinary circumstances and part of what enables them to be courageous is the compassion of those caring for them. It behooves us then to care for ourselves so that we can better care for our patients“ (Pepper et al., 2012).

Further Research was held in 2017 and a national evolution of Rounds in England was conducted by a team of researchers who provided data on the improvement of staff wellbeing (BMJ, 2018).

Compassion should be an ethical commitment and a constant reminder to take care of both patients and ourselves in acts of finest concern (Lown, 2014). This proposal will need fundamental and outstanding support from both immediate leadership and organizational management in order to help and engage staff over a long term. The Schwartz Center for Compassionate Healthcare in Boston aims to implement Schwartz Center Rounds® in 450 health care organisations, and this all started with one patient‘s story. Schwartz (1995) mentioned “If I have learned anything, it is that we never know when, how, or whom a serious illness will strike. If and when it does, each one of us wants not simply the best possible care for our body but for our whole being“.

As a long-term committed nurse and educator in Germany, I can realistically recommend that the approach of implementing Schwartz Center Rounds® in Germany would be beneficial for their 1,200,000 healthcare staff.

About The Author

Andrea Roth is currently studying the MSc Integrative Health and Social Care with the University of Derby Online Learning (UDOL), having completed her BSc (Hons) Nursing Studies Top-Up degree in 2016.

To find out more about studying an online health and social care degree with UDOL please visit their website.

References

_{BostonGlobe.com, (2014). One patient’s call for compassion becomes a movement – The Boston Globe. [online] Available at: http://www.bostonglobe.com/lifestyle/health-wellness/2012/07/15/one-patient-call-for-compassion-becomes-movement/9007EmgC3R0G0JszUoBNnO/story.html}

_{Cole-King, A, & Gilbert, P (2011), ‘Compassionate care: the theory and the reality’, Journal Of Holistic Healthcare, 8, 3, pp. 29-37, Academic Search Index}

_{Dame Carol Black, (2015): https://de.slideshare.net/IIPSouthofEngland/health-and-wellbeing-in-the-working-environment}

_{Gilbert, P (2009), The Compassionate Mind / Paul Gilbert, n.p.: London : Constable, 2009.,}

_{Lown, B (2014), ‘Toward more compassionate healthcare systems Comment on “Enabling compassionate healthcare: perils, prospects and perspectives”‘, International Journal Of Health Policy And Management, 2, 4, pp. 199-200, MEDLINE,}

_{Lown, B, & Manning, C n.d, (2010) ‘The Schwartz Center Rounds: Evaluation of an Interdisciplinary Approach to Enhancing Patient-Centered Communication, Teamwork, and Provider Support’, Academic Medicine, 85, 6, pp. 1073-1081,}

_{Pepper, J, Jaggar, S, Mason, M, Finney, S, & Dusmet, M (2012), ‘Schwartz Rounds: reviving compassion in modern healthcare’, Journal Of The Royal Society Of Medicine, 105, 3, pp. 94-95, MEDLINE}

_{Pointofcarefoundation.org.uk, (2014). Point of Care – News and Events.“How Schwartz Center Rounds® can help maintain staff wellbeing and quality of patient care“[online] Available at: http://www.pointofcarefoundation.org.uk/News-And-Events}

_{Quality Improvement devision, Ireland, (2018): https://www.hse.ie/eng/about/who/qid/staff-engagement/schwartzrounds/}

_{Robert, Philippou, Leamy, Reynolds, Ross, Bennett, Taylor, Shuldham, Maben:}

_{(2018), available at BMj. http://bmjopen.bmj.com/content/7/1/e014326}

_{Schwartz, KB, (1995), `A patient´s story`The Boston Globe Magazine, 16 July available from www.theschwartzcenter.org/viewpage.aspx?pageld=50 Theschwartzcenter.org, (2014). The Schwartz Center for Compassionate Healthcare. [online] Available at: http://www.theschwartzcenter.org/aboutus/ourstory.aspx}

_{The King’s Fund, (2018) ‘The contribution of Schwartz Center Rounds® to hospital culture 2012 | The King’s Fund’ [online] Available at: http://www.kingsfund.org.uk/publications/articles/contribution-schwartz-center-rounds-hospital-culture-2012}

_{The Schwartz Center for Compassionate Care, Boston, (2018) : available: http://www.theschwartzcenter.org}

_{The Health Foundation, (2016): https://www.health.org.uk/blog/making-case-staff-wellbeing-nhs}