A Longitudinal National Evaluation of Schwartz Centre Rounds®
Start date
27 June 2018End date
30 September 2018Abstract
Background
Schwartz Center Rounds® are recommended as an organisational intervention to enhance the quality of patient care by providing emotional support to staff through reflection and facilitated group discussion. Initiated by the 'Schwartz Center for Compassionate Care' in Boston USA they were brought to the UK by the Point of Care Programme in 2009. To date, evidence of benefit has relied upon relatively weak design and small scale evaluations. Due to the rapid uptake and growing interest in Rounds, UK research is now needed to determine what mechanisms affect their uptake and successful implementation at the organisational level, as well as determine their impact on individual staff wellbeing and the culture of teams and the wider organisation.
Aims
- To investigate contexts in which/mechanisms whereby Rounds influence staff wellbeing at work and social support
- To identify and evaluate any changes in relationships between staff who attend Rounds and their patients/colleagues
- To identify/consider any wider changes in teams/the wider organisation in relation to the quality of patient care and staff experience and to suggest whether/how these may be linked
Research question: To what extent is participation in Rounds associated with enhanced staff wellbeing at work, social support for staff and improved relationships between staff and patients including compassion and empathy?
Methods and analysis
Longitudinal evaluation of Rounds using mixed methods, underpinned by realist evaluation to determine what works for whom in what circumstances in terms of the impact of Rounds on staff well-being and staff capacity to deliver patient-care compassionately.
Phase 1: Scoping review of the literature including comparison with alternative interventions; Rounds Provider Mapping & costs: profile of all UK Rounds provider organisations at 1 September 2014 and reasons for adoption (interviews with key Rounds champions).
Phase 2: Survey and organisational case studies
Thirteen providers were purposively sampled from Phase 1 data; ten sites for the survey, and nine for organisational case studies. Six sites participated in both.
Phase 2a) Longitudinal survey in 10 sites (baseline/8 months) to 800 attenders and 2500 controls to measure changes in staff work wellbeing, social support and relationships with staff and patients.
Phase 2b): Ethnographic field work in 9 sites: including observation and interviews with Rounds facilitators; presenter teams in Rounds and in practice; attenders, non-attenders and stakeholders. Synthesis of findings from Phases 1&2 to produce recommendations. OUTPUTS 1. A review of evidence base to determine mechanisms by which Rounds may 'work' 2. Descriptive profiles of current provider organisations including reasons for adoption and associated costs. 3. Relationship of Rounds attendance to self-reported changes in staff wellbeing, social support and behaviour towards patients and colleagues 4. In-depth understanding of the process of Rounds and the mechanisms and contexts in which they may (or may not) be (i) effective for staff and (ii) impact on patient care 5. An understanding of any wider changes in teams or across the wider organisation in terms of quality of patient care, and staff experience. Few interventions exist to support staff with the emotional aspects of providing patient care and to sustain compassion in practice, and even fewer have been evaluated. This robust evaluation will provide evidence for the NHS/other providers regarding the potential effectiveness of Rounds as an intervention to support staff and has the potential to affect patient care quality and practice.
The project is listed on the National Institute for Health Research (NIHR) site.
Funder
Team
Professor Jill Maben
Principal investigator
Biography
Jill is a nurse and social scientist and her research focuses on supporting staff to care well for patients. Jill qualified as a Registered nurse at Addenbrookes in Cambridge and studied History at UCL, before undertaking her Masters in Nursing at King's College London and completing her PhD at the University of Southampton. She completed her PGCE at the London School of Hygiene and Tropical Medicine in 2007. Jill was deputy Director (2007-2010) and Director (2011-2014) of the Policy Research Programme's National Nursing Research Unit at King's College London.
Jill was awarded an OBE in June 2014 for services to nursing and healthcare. In 2013 she was in the Health Services Journal ‘Top 100 leaders’ and was also included on Health Service Journal’s inaugural list of Most Inspirational Women in Healthcare the same year.
Jill is passionate about creating positive practice environments for NHS staff and supporting staff in the work they do caring for patients and her programme of research has highlighted the links between staff experiences of work and patient experiences of care- https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/081819213/#/ This was one of the first studies to demonstrate relationships between staff wellbeing and patient experience at the team and individual level demonstrating that staff wellbeing is an important antecedent of patient care performance.
Jill's doctoral work examined what supported and what prevented newly qualified nurses implementing their ideals and values in practice, highlighting how ideals and values of new nursing students can become compromised and crushed in poor work environments. She also recently completed the first national evaluation of Schwartz Centre Rounds in the UK: “A Longitudinal National Evaluation of Schwartz Centre Rounds®: an intervention to enhance compassion in relationships between staff and patients through providing support for staff and promoting their wellbeing” [https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/130749/#/] she has developed a short film from this work: Understanding Schwartz Rounds: Findings from a National Evaluation https://www.youtube.com/watch?v=C34ygCIdjCo
Other recent studies include an evaluation of patient and staff experiences and safety outcomes of a move to 100% single hospital bedrooms. [https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/10101342/#/] and interventions to support healthcare staff including Schwartz Center Rounds and to improve relational care for older people in hospital [https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1212910/#/] The single room evaluation work is now being replicated in Australia; Holland and Denmark.
Current studies include the Impact of Covid on Nurses (ICON) (Burdett Trust; Florence Nightingale Foundation and the Colt Trust) and NIHR studies:
Care Under Pressure 2: Caring for the Carers a realist review of interventions to minimise the incidence of mental ill-health in nurses, midwives and paramedics: www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR129528/#/ and
Strategies to address unprofessional behaviours among staff in acute healthcare settings: a realist review: www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR131606/#/
Professor Cath Taylor
Co-investigator
Biography
I am Professor of Healthcare Workforce Organisation and Wellbeing in the School of Health Sciences at the University of Surrey. I have worked in Health Services Research since 1997, following completion of a Psychology degree at Swansea University. My academic career began at Imperial College London (1997-2002) followed by Kings College London (2002-2017).
My main research interests are improving the wellbeing of the NHS workforce and assessing and improving multidisciplinary team working in healthcare teams. In relation to the wellbeing of NHS staff, I have conducted national cohort studies of mental health in hospital consultants, and worked alongside Professor Jill Maben (also at University of Surrey) to complete a national evaluation of Schwartz Center Rounds in the UK, funded by the NIHR. I am currently funded by NIHR to complete a realist synthesis aimed at understanding how to improve mental wellbeing in nurses, midwives and paramedics. My work in relation to multidisciplinary teams led to the development of a cancer multidisciplinary team assessment and feedback tool (named MDT-FIT) that won QiC Oncology Digital Innovation of the Year in 2016. I am currently working with Surrey and Sussex Cancer Alliance to support and evaluate improvements to multidisciplinary team meetings across three tumour pathways.
Professor Jeremy Dawson
Co-investigator
Dr Caroline Shuldham
Co-investigator
Dr Catherine Foot
Co-investigator
Outputs
Introducing and understand Schwartz Rounds® for allied health professionals, findings from a national evaluation.
Understanding Schwartz Rounds®: A film based on our evaluation
NIHR report
Publications
- Realist evaluation of Schwartz rounds® for enhancing the delivery of compassionate healthcare: understanding how they work, for whom, and in what contexts.
- Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation.
- “Schwartz Center Rounds: an intervention to enhance staff well-being and promote organisational change”. Book chapter in “The Triple Challenge: Connecting Health care worker well-being, patient safety and organisational change”.
- ‘We needed to talk about it’: The experience of sharing the emotional impact of healthcare work as a panellist in Schwartz Center Rounds in the UK.
- I can’t stop thinking about it”: Schwartz Rounds an intervention to support students and higher education staff with emotional, social and ethical experiences at work.
- The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds from the United states to the United Kingdom.
- Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009–2015.
- Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews.
Organisational guide
Download our organisational guide
We are happy to provide this free of charge, but would ask you to have regard to the following conditions on its use:
- Do not distribute this to anyone else – if anyone asks for a copy please ask them to obtain it via this project page.
- If you use the guidance, or any part of it, we would be grateful if you would please:
- Acknowledge the authorship team;
- Send copies of any reports/papers that are produced to Professor Jill Maben (J.Maben@surrey.ac.uk)
- Let us have any comments/suggestions that you feel might improve the guidance so that your experience can be incorporated into subsequent updates.
Download a copy of An Organisational Guide: Understanding, Implementing and Sustaining Schwartz Rounds®.
Research groups and centres
Our research is supported by research groups and centres.
Workforce, organisation and wellbeing research