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NHS using Schwartz scheme to aid staff wellbeing rather than just care

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A staff initiative that sees professionals meet and discuss the emotional side to their work is being used in England on the basis that it helps workers’ wellbeing rather than solely improving care for patients as was originally intended, research has suggested.

Academics at King’s College London led a study of Schwartz Rounds, an initiative that originated in the US more than a decade ago, to see how far the idea had been adopted in England.

“[We] consistently found that explanations for adoption related to staff well-being…[which] differs from the original aim”

KCL paper on Schwartz Rounds 

They found a total of 116 organisations in England had introduced the scheme by July 2015 – the vast majority of which were NHS acute, community and mental health services. The rest included 25 hospices and four other employers, such as a private hospital.

Overall, 44% of all 155 NHS acute providers in England had Schwartz Rounds taking place, according to the study, published in the British Medical Journal.

The researchers also looked at why employers in England had brought in the initiative, which sees nurses and other multi-disciplinary team members attend an hour-long confidential meeting, usually monthly, to discuss the psychological, emotional and social challenges associated with their work.

They ”consistently found that explanations for adoption related to staff well-being”.

“If adoption was proposed by a group of enthusiasts who were willing to manage implementation and funding could be secured…then rounds were perceived as ‘worth trying’”

KCL paper on Schwartz Rounds 

“This differs from the original aims of rounds – as developed in the USA – where they were commonly and explicitly framed as an innovation for improving compassionate care for patients,” said the research paper.

Increasing numbers of UK organisations began to adopt the initiative following the publication of the Francis report in 2013, which investigated care failings at the former Mid Staffordshire NHS Foundation Trust and highlighted Schwartz Rounds as being a way of fostering good teamwork, said the study paper.

From interviews with 45 staff members who led rounds in their organisation, researchers found the meetings were viewed as a demonstrable response to the Francis report.

However, the study concluded it was down to a “confluence of factors” that Schwartz Rounds had caught on across the country. These included the low cost of introducing them, and professionals advocating their use.

The study found senior nurses – up to the director of nursing – were important in initiating the adoption of rounds.

“[The adoption of Schwartz Rounds] has not been driven in a significant way by any ‘felt need’ to respond to ‘poor’ performance”

KCL paper on Schwartz Rounds

“If adoption was proposed by a group of enthusiasts who were willing to manage implementation and funding could be secured for most of the set up costs, then rounds were perceived as ‘worth trying’,” said the research paper, called Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009–2015.

“Overall, it appeared to be relatively straightforward to gain approval for – and there was little resistance to – introducing rounds in the majority of organisations,” it added.

The research team, led by Glenn Robert at the Florence Nightingale Faculty of Nursing and Midwifery at KCL, also said it was “striking” how many professionals spoke positively about visiting a neighbouring hospital that had already introduced the scheme.

They noted that a visit to another organisation was a mandatory step in securing a licence from the Point of Care Foundation charity to run Schwartz Rounds in the UK.

Further analysis of organisation performance metrics – including Care Quality Commission ratings and inpatient surveys – found a weak association between employers with Schwartz Rounds and higher levels of staff engagement, compared with those that had not introduced the initiative.

King's College London

Ward scheme ‘increased quality but not productivity’

Glenn Robert

They also found a weak association between organisations that had brought in rounds earlier on and higher patient experience measures, compared with those employers that implemented the scheme at a later stage.

But the researchers highlighted the pattern of adopting Schwartz Rounds “has not been driven in a significant way by any ‘felt need’ to respond to ‘poor’ performance”, and had also not been influenced by a strong evidence base.

“A confluence of factors…initially led to [Schwartz] Rounds being seen as ‘an idea whose time had come’,” said the study paper.

“More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of ‘mimetic pressure’,” it concluded.

The Point of Care Foundation told Nursing Times that the model of Schwartz Rounds being implemented in England was the same as the one developed in the US.

It said that professionals in England were increasingly making the case to employers for the initiative’s adoption by pointing to the benefits for staff wellbeing, due to more recent research that had shown this led to compassionate care.

Joanna Goodrich, head of evidence and learning at The Point of Care Foundation, said: ”Our workshops with clinicians and researchers showed that unless staff were supported and cared for it was very difficult for them in turn to be compassionate towards their patients.

“The link between staff wellbeing and compassionate care and patient wellbeing has been established through research for some years now. We have moved on and it is now recognised they are integral to eachother.”

“We welcome the fact that the rounds are being introduced within the framework of staff wellbeing,” she added.

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