A Longitudinal National Evaluation of Schwartz Centre Rounds®

About the project

Research type

Mixed methods realist evaluation

Chief investigator

Co-investigators

  • Dr Cath Taylor
  • Professor Jeremy Dawson
  • Dr Caroline Shuldham
  • Catherine Foot

Funding source(s)

National Institute for Health Research (Health Services and Delivery Research programme)

Started

September 2014

Status 

Project completed March 2017 – final reported to be published March 2018

Abstract

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 

  1. To investigate contexts in which/mechanisms whereby Rounds influence staff wellbeing at work and social support
  2. To identify and evaluate any changes in relationships between staff who attend Rounds and their patients/colleagues
  3. 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.

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:

  1. Do not distribute this to anyone else – if anyone asks for a copy please ask them to obtain it via the website: www.surrey.ac.uk/SchwartzEvaluation.
  2. 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®.

Understanding Schwartz Rounds: A film based on our evaluation