Schwartz Centre Rounds

1. Schwartz Centre Rounds

2. Structure of talk • What is the problem? • What is the effect of the problem? • What can help? • What is a Schwartz Round? • Impact of Schwartz Rounds • Implementing Schwartz Rounds • Schwartz Centre Rounds

3. At the extreme end What is the problem?

4. What is the problem? Schwartz Centre Rounds Unreliable quality of care Evidencefrom 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 1. Dixon-Woods et al mixed methods study published in BMJ Sept 2013 report

5. What is the problem? (continued) Schwartz Centre Rounds 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

6. What is the problem? (continued) Pressures on staff wellbeing • 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 • Schwartz Centre Rounds

7. What is the effect of the problem? Schwartz Centre Rounds 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

8. What is the effect of the problem? (continued) Schwartz Centre Rounds 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

9. What is the effect of the problem? ContinuedDr 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 Schwartz Centre Rounds

10. What helps? Schwartz Centre Rounds 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)

11. What helps? (Continued) Schwartz Centre Rounds 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)

12. What helps? (Continued) Schwartz Centre Rounds Effective interventions Does it directly reflect or is it compatible with a systems perspective? Is it described in enough practical detail to replicate elsewhere? Is it flexible, can it be adapted to different environments? Has it been sustained or spread beyond the place where it originated? Has it been subject to an external process of assessment or evaluation? Source: Adapted from Greenhalghet al 2004. Goodrich J, Cornwell J 2008 Seeing the Person in the Patient King’s Fund.

13. Schwartz Centre Rounds

14. Organisations running Rounds by type (Oct ‘14) Schwartz Centre Rounds

15. 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

16. What is a Schwartz Round? Schwartz Centre Rounds 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=JUk-mIGZm7s

17. What is a Schwartz Round? (Continued) Schwartz Centre Rounds 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

18. What is a Schwartz Round? (Continued) Schwartz Centre Rounds 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

19. Impact of Schwartz Rounds Schwartz Centre 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 patient-centred communication, teamwork and provider support. Academic Medicine 85(6).

20. Impact of Schwartz Rounds (Continued) Schwartz Centre Rounds 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?’JRSoc Med 2012: 105:117-122 A number of other published studies report positive results

21. Impact of Schwartz Rounds (Continued) Schwartz Centre Rounds 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

22. Impact of Schwartz Rounds (Continued) Schwartz Centre Rounds What did participants say? INSERT FROM CHOICE OF QUOTES BELOW

23. 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

24. Implementing Schwartz Rounds Schwartz Centre 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.

25. Contact details Esther FlanaganProgramme Manager estherflanagan@pointofcarefoundation.org.uk Joanna GoodrichResearch and Development Manager joannagoodrich@pointofcarefoundation.org.uk Rhiannon BarkerProgramme Manager rhiannonbarker@pointofcarefoundation.org.uk

26. The Point of Care Foundation 11-13 Cavendish Square, London W1G0AN jocelyncornwell@pointofcarefoundation.org.uk www.pointofcarefoundation.org.uk

27. Cancer services Schwartz Centre Rounds 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.