Last week, I co-facilitated a Schwartz Round with students at the University of Liverpool. This was the sixth Round we have run with students at the university. I first heard about Schwartz Rounds at a conference I attended several years ago. The presenter's enthusiasm for Rounds sparked an interest in me. I was keen to know more but also curious to know whether the Rounds offered anything additional to the reflective spaces I was already familiar with in my work as a clinical psychologist. Did Schwartz Rounds offer anything different or better?
So, what are Schwartz Rounds? Rounds are for all staff working in healthcare settings to come together once a month to discuss and reflect on the emotional impact of their work. The Rounds are named after Kenneth Schwartz, a healthcare lawyer who died in 1995 from lung cancer at the age of 41. Before his death, he set up the Schwartz Center for Compassionate Healthcare, in the USA, with the aim of nurturing compassion in healthcare – to make "the unbearable bearable" through "the smallest acts of kindness" and to strengthen the relationship between patients and their caregivers.
Based on the idea of a Grand Round, Schwartz Rounds provide a facilitated reflective space, lasting for one hour. Schwartz Rounds are licensed in the UK by the Point of Care Foundation. Over 130 healthcare organizations (mainly NHS Trusts and some hospices) are running Rounds now in the UK. Key features of Rounds include the provision of food and refreshments before the Round begins; three or four panel members talking for five minutes on a topic each, in turn, uninterrupted and members of the audience being invited to share their thoughts and to share similar experiences and stories. Two trained facilitators contain and shape the discussion and help to steer the conversation away from problem solving/case discussions.
As part of the development of Schwartz Rounds in the North West of England (supported by Health Education England (in the North West) and hosted by the Psychological Professions Network), I had the opportunity to experience a Round for the first time, in July 2015, as a panellist. Speaking, uninterrupted, for five minutes on the theme of "A patient I will never forget" and hearing my fellow panellists' stories and the contributions from the audience, was emotionally powerful. I was struck, as I have been in every Round since, by how actively and attentively those in the audience listened - clearly, something special was happening.
Our University of Liverpool Schwartz Round project is funded by Health Education England (in the North West)'s Forerunner fund). So far, we have run Rounds with students from medicine, clinical psychology, nursing, occupational therapy, physiotherapy, diagnostic radiography, radiotherapy and orthoptics. We were the first UK university to run multiprofessional Rounds with students and were proud to receive an award for "Best Schwartz Innovation" by the Point of Care Foundation in November 2016.
The topic themes for our Rounds so far have included "A patient I will never forget"; "Accepting that we cannot fix everything" and "Speaking up or keeping quiet". The response from students who have attended the Rounds has been overwhelmingly positive. Students' feedback highlights the importance of having the space and time to reflect on the emotional impact of healthcare work, on the importance of normalising strong emotions that arise from our work in healthcare and on appreciating being with students from other healthcare professions Here are some of their words:
"Found it insightful and encouraging in that the experiences I've had with patients are shared by many and it's normal to get emotional."
"...a way of maintaining empathy at work by acknowledging there isn't always a right answer and that the work is about more than robotically following guidelines."
"I felt Schwartz rounds successfully assisted in breaking down professional barriers and through the process of reflection generated a mechanism of continuous learning- serving to improve my future delivery of care."
An account of two of our Rounds, written by Rhiannon Barker from the Point of Care Foundation, can be read at:
So, to the future... We hope keep on running Rounds at the university. Whilst they are received very positively, we need to know more about the Rounds' active ingredients, to understand the psychological mechanisms underpinning the process of the Rounds and to know more about their impact on students' levels of empathy, resilience, compassion, self-reflection and well-being. Our research, which runs alongside running the Rounds, will help us to answer these questions. Ultimately, we hope that attending Rounds will contribute to our healthcare students' career-long ability to deliver compassionate care – to make, as was the wish of Kenneth Schwartz, the unbearable bearable through the smallest acts of kindness.
Laura Golding, Programme Director, Doctorate in Clinical Psychology, University of Liverpool