Schwartz Centre Rounds
The Point of Care Foundation ©
1
Structure of talk
① What is the problem?
② What is the effect of the problem?
③ What can help?
④ What is a Schwartz Round?
⑤ Impact of Schwartz Rounds
⑥ Implementing Schwartz Rounds
The Point of Care Foundation ©
Schwartz Centre Rounds
2
What is the problem?
At the extreme end
The Point of Care Foundation ©
3
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
The Point of Care Foundation ©
Schwartz Centre Rounds
1. Dixon-Woods et al mixed methods study published in BMJ Sept 2013 report
4
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
The Point of Care Foundation ©
Schwartz Centre Rounds
5
What is the problem? (continued)
Pressures on staff wellbeing
o
In 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
The Point of Care Foundation ©
Schwartz Centre Rounds
6
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
The Point of Care Foundation ©
Schwartz Centre Rounds
7
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
The Point of Care Foundation ©
Schwartz Centre Rounds
8
What is the effect of the problem? Continued
Dr Kieran Sweeney GP, academic, patient
“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
The Point of Care Foundation ©
Schwartz Centre Rounds
9
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)
The Point of Care Foundation ©
Schwartz Centre Rounds
10
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)
The Point of Care Foundation ©
Schwartz Centre Rounds
11
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.
The Point of Care Foundation ©
Schwartz Centre Rounds
12
Schwartz Centre
Rounds
The Point of Care Foundation ©
13
Organisations running Rounds by type (Oct ‘14)
The Point of Care Foundation ©
Schwartz Centre Rounds
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
The Point of Care Foundation ©
15
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=JUkmIGZm7s
The Point of Care Foundation ©
Schwartz Centre Rounds
16
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
The Point of Care Foundation ©
Schwartz Centre Rounds
17
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
The Point of Care Foundation ©
Schwartz Centre Rounds
18
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 patientcentred communication, teamwork and provider support. Academic Medicine 85(6).
The Point of Care Foundation ©
Schwartz Centre Rounds
19
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
The Point of Care Foundation ©
Schwartz Centre Rounds
20
Impact of Schwartz Rounds (Continued)
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
The Point of Care Foundation ©
Schwartz Centre Rounds
21
Impact of Schwartz Rounds (Continued)
What did participants say?
INSERT FROM CHOICE OF QUOTES BELOW
The Point of Care Foundation ©
Schwartz Centre Rounds
22
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
The Point of Care Foundation ©
23
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.
The Point of Care Foundation ©
Schwartz Centre Rounds
24
Contact details
Esther Flanagan
Programme Manager
estherflanagan@pointofcarefoundation.org.uk
Joanna Goodrich
Research and Development Manager
joannagoodrich@pointofcarefoundation.org.uk
Rhiannon Barker
Programme Manager
rhiannonbarker@pointofcarefoundation.org.uk
The Point of Care Foundation ©
25
The Point of Care Foundation
11-13 Cavendish Square, London W1G0AN
jocelyncornwell@pointofcarefoundation.org.uk
www.pointofcarefoundation.org.uk
The Point of Care Foundation ©
26
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.
The Point of Care Foundation ©
Schwartz Centre Rounds
27