The Schwartz Center Rounds:
supporting people who work within a
mental health NHS Trust with the emotional
impact of their work
Psychiatry School Conference
November 2013
Lyndsay Swift
Dr Rob McFarland
Aim of the presentation
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Introduce the Schwartz Rounds
Where they came from and what they are
How they may support professionals
What they hope to achieve
How they are run
Introduce the research
Present findings
Introduce the Schwartz Rounds
• Where they came from:
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Ken Schwartz
A Health analyst in the USA
Attended hospital for treatment of lung cancer
Found the treatment good, but no support for
the emotional impact of getting the diagnosis
• Returned to work and explored this and the
Schwartz Rounds were born!
What are the Schwartz Rounds?
• Widely used in the USA
– Schwartz Center Rounds®
– The Schwartz Center for compassionate
healthcare
• www.theschwartzcenter.org
• Brought to the UK by The Kings Fund
– The Point of Care programme
• www.kingsfund.org.uk
What are the Schwartz Rounds?
• The Rounds came from oncology/physical
health settings
• They have been run in:
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Palliative care
Hospice
Heart surgery wards (Royal Brompton Hospital)
National spinal injuries ward (Stoke Mandeville)
• Our Trust is the first to apply the Rounds in
mental health
– Dealing with emotion IS the work!
What are the Schwartz Rounds?
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A monthly meeting, for 1 hour, for a defined group
Lunch HAS TO be provided
An open meeting
A space and a place to discuss the emotional impact
of the work we do
– They are NOT clinical Supervision (group or individual)
– They are NOT a de-brief
– They are NOT a place to problem solve or discuss care
planning
• They are a place to BE WITH how work affects us and
to share how we feel
What are the Schwartz Rounds?
• Each Round has a dedicated speaker(s)
(Volunteers!)
• Speakers speak for about 15 minutes on their
chosen topic area
• The remaining 45 minutes are for the Round
attendees to:
– Share how they felt about the topic
– Share their experience of a similar situation
– Share how they would have felt in that situation
What are the Schwartz Rounds?
• Each Round has a Chair:
– For us, this is a ward manager (nurse)
• Each Round has a facilitator:
– For us, and for most of the Rounds in the UK, this
is a Clinical Psychologist
• The facilitator meets with the speakers prior
to the Rounds, to ‘run through’ the Rounds,
so people feel safe
• Each Round has a Steering group
What they hope to achieve
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Cathartic?
De-shaming?
Understanding of each others roles?
Affirmation of the reasons why we come to work?
Sharing a common humanity?
A recognition from the organisation that work has
an emotional impact
• A recognition that time is needed in work to
process/discuss the emotional impact of the work
• Caring for the people that care
What is Compassion?
• “…a sensitivity to the suffering of self and
others, with a deep commitment to try to
relieve it.”
The Dalai Lama (1995)
Components of Compassion
WARMTH
WARMTH
WARMTH
WARMTH
Adapted from Gilbert (2009)
What gets in the way of being compassionate?
Looking beyond the individual
• Organisations may encourage compassion or stifle it.
• Competitive business culture – drive for efficiency:
– demands & pressures upon patient care can hinder
professionals’ ability to provide a compassionate service, which
can mean less 1 to 1 patient care (Sanghavi, 2006)
• Reward systems or threat systems (linked to targets)
– employees are likely to be most stressed when they experience
high demands, have little control over workload & low support
(Evans et al., 2006: Citing Karasek (1979)
– Time demands, bureaucratic paperwork (defensive practice)
• These all create unpleasant & draining work environments for
service users & employees
Potential benefits of giving compassion
care
• Compassionate clinical relationships prevent health
problems & promote faster recovery (Hamilton, 2010)
• Patients are more likely to disclose concerns,
symptoms & behaviours, helping to inform treatment
plans, improve outcomes & increase satisfaction.
(Halpern, 2001; Larson, 2005; Sanghavi, 2006).
• Relationships can be enhanced across professions,
leading to greater awareness of cultural beliefs &
more supportive environments for staff (Lown &
Manning, 2010)
Potential benefits of giving compassion
care
• Boyatzis et al., 2006:
– creativity and decision making can also be enhanced
in less stressful environments, where people feel
more supported within their organisation
• The Health of the Nation (Secretary of State for
Health; 1992):
– health improvement and promotion strategies within
the workforce at large can be significant in
developing improvements in overall health.
Potential benefits of giving compassion
care
• Prosser et al.; 1996:
– Mental health professionals commonly face
highly emotive situations:
• supporting people who are suicidal and who may
have made attempts upon their life.
• experiencing threats of violence in their day to
day lives
Matthieu Ricard
• “…even though there can be “empathy fatigue,”
there cannot be “compassion fatigue,” since
compassion is essentially a wholesome, positive
state of mind, while empathy is only the tool that
allows one to correctly perceive the state of mind
of others. The more one experiences compassion
and loving kindness, the more one progresses
towards authentic well-being, and becomes
unconditionally available to others...”.
– http://www.huffingtonpost.com/matthieuricard/could-compassion-meditati_b_751566.html
Potential benefits of giving compassion
care
• “By developing health care systems that
facilitate compassionate care, our
patients' experiences & clinical outcomes
will be better, our own risks of burnout or
litigation will be less, & our job
satisfaction will be considerably greater”
– (Cole-King & Gilbert 2011)
Our Rounds
• Backed by the Kings Fund
• Pilot of 6 months in acute mental health care
(Radbourne Unit, Derby)
– November 2011-April 2012
• 93 people attended at least 1 Round (from 150
people invited; 62%)
• 33 people attended more than 1 Round (35%
attendees; 22% of everyone invited)
Our rounds
• 3 sites:
- Derby (Radbourne Unit)
- Chesterfield (Hartington Unit)
- HMP (Prison Inreach)
• Attendance across MH sites:
- Total = 270
- 31% attended more than 1 round
Round topics
• “He’s going to kill me…what should I do?”
- A professional’s experience of being attacked by a
service user
• “A day at work I will never forget”
- A professional discussing a day when a service user
had her children taken away from her
• “Too close to home”
- A professional’s experience working with a service
user who had similar difficulties to their relative
Round topics
• “The lonely walk”
- A professional talking about what it was like doing
ward observations, believing the patient would kill
themself
• “I’m pregnant!”
- A professionals experience of working in MHS
whilst pregnant
• “Positive risk taking, a frightening experience”
- An OT’s perspective facilitating discharge into the
community
Words used to summarise rounds
engaging
supportive
empathetic
essential
insightful
emotional
reflective
worthwhile
normalising
connecting
validating
refreshing
enlightening
honest
Comments from the Rounds
• The rounds were useful:
– The expression of emotion
• Sharing how people feel
• Validation of feelings
‘Pat’ “you’ve
got a chance to
vent your
positive and
your negative
feelings in quite
a protective
place”
Comments from the Rounds
• Relevant to everyday issues:
‘Pat’ “last week’s was quite
powerful for us…I think that
was because it was very
clinical based. It sort of
touched on a lot of things a
lot of us have gone through”
‘Ann’ “…his
reflections
helped us to
think about if
we had been in
that situation
how we’d sort
of coped with it
and things”
‘Pat’ “it’s something that
we can relate to our
practice, that one
[referring to a particular
Round] was very in touch
with what we’re doing
today”
Comments from the Rounds
• Food:
– Feeling valued
“Often we come in our lunch
time …because they don’t have
lunch [on the ward], they have to
have it running”
‘John’ “[Food is an
incentive]. It invites a
group…I think it gets
people there, it’s an opener
I think and creates an
atmosphere of caring”
– Management commitment to compassion
‘John’ “someone’s put money into it,
which is about corporate will…because
they don’t do that in any other forum…I
don’t if other people would perceive it as
that but for me that stood out”
Comments from the Rounds
• Negative views:
– Pat’ “because of timing, I was in charge of the afternoon shift
so I had to go [fifteen minutes before the end] so we didn’t
see the end of it and a student nurse came with me and when
we both…left and [said], ‘whoah, that was quite powerful and
emotional’ but you had to go back to the ward and get back
into the hustle and bustle of it all”
– Sharon’ “…we come in and listen to somebody put …their
story and their experiences and I think everyone in the room
could relate to that in a way, but then we go away, we go back
to work but we don’t always get that chance to say ‘oh yeah…I
could relate to that’. I think if you went to every one, if
everyone had an opportunity to say their piece as well, it’d
feel more rounded”
Comments from the Rounds
The Rounds have room for improvement:
– ‘John’ “it is very hard to get people consistently to
[attend]. It’s a big unit, the shift system, very busy,
demands to go back, so the fact that it happened…to
get that many people there was pretty good”
– ‘Pat’ “now more people are getting to know that
they’re there, I think more people are trying to make
the effort to try and get to them”
Comments from the Rounds
– ‘Ann’ “I think it can be quite intimidating to speak up
in a room where there’s lots of people from lots of
different teams. If this sort of thing was happening
within the team that you worked [in], you might feel
more comfortable to put your point of view across
but you might think ‘I don’t know if this is going to
come across right or there’s lots of people looking at
me, is it ok for me to say this?’. Obviously it’s made
clear that everybody’s contribution is welcomed and
as much is done as can be to try and make people
feel relaxed.”
– ‘Jane’ “I don’t think enough people know about it for
it to have had an impact necessarily on the wards at
the minute”
References
• Boyatzis, R., Smith, M. & Blaize, N. (2006). Developing sustainable
leaders through coaching and compassion. Academy of
Management Learning and Education, 5, 8-24.
• Cole – King, A. & Gilbert, P. (2011). Compassionate care: the theory
and the reality. Journal of Holistic Healthcare, Vol 8 (3) 29-37
• Cornwell, J. (2009). See the person in the healthcare professional:
how looking after staff benefits patients. Nursing Times, 105 (48),
10-12
• Cornwell, J. & Goodrich, J. (2010). Supporting staff to deliver
compassionate care using Schwartz Centre Rounds- a UK pilot.
Nursing Times, 106 (5), 10-12
• Dalai Lama (1995). The Power of Compassion. India: Harper Collins.
• Gilbert, P. (2010). Compassion Focused Therapy: Distinctive
Features. Routledge: London.
References
• Evans, S., Huxley, P., Gately, C., Webber, M., Mears, A., Pajak, S.,
Medina, J., Kendall, T. & Katona, C. (2006). Mental health, burnout
and job satisfaction among mental health Social Workers in England
and Wales. British Journal of Psychiatry, 188, 75-80.
• Karasek, R. (1979). Job demands, job decision latitude and mental
strain. Implications for job redesign. Administrative Quarterly, 24,
285-308.
• Lown, B., Manning, C. (2010). The Schwartz Center Rounds:
Evaluation of an interdisciplinary approach to enhancing patientcentered communication, teamwork, and provider support.
Academic Medicine, 85 (6), 1073-1081
• Matthews D.A., Suchman A.L., Branch W.T. (1993). Making
“connexions”: Enhancing the therapeutic potential of patientpatient-clinician relationships. Annals of Internal Medicine, 118,
973–977.
• Prosser, D., Johnson, S., Kuipers, E., Szmukler, G., Bebbington, P. &
Thornicroft, G. (1996). Mental health ‘burnout’ and job satisfaction
among hospital and community-based mental health staff. British
Journal of Psychiatry, 169, 334-337.
References
• Sanghavi, D. (2006). What makes for a compassionate
patient-caregiver relationship? Journal on Quality and
Patient Safety, 32 (5), 283-292.
• Secretary of State for Health (1992). The Health of the
Nation. A Strategy for Health in England. London:
HMSO.
• The Schwartz Center for compassionate healthcare.
(www.theschwartzcenter.org)
• Thi, P., Briaçon, S., Empereur, F. & Guillemin, F. (2002).
Factors determining inpatient satisfaction with care.
Social Science & Medicine, 54, 493-504.
Thank you for listening
Are there any questions?