Background
Schwartz Center Rounds® (Rounds) were introduced into the UK in 2009 to support health-care staff to deliver compassionate care, something the Francis report (Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office; 2013) identified as lacking. Rounds are organisation-wide forums that prompt reflection and discussion of the emotional, social and ethical challenges of health-care work, with the aim of improving staff well-being and patient care.

Objectives
How, in which contexts and for whom Rounds participation affects staff well-being at work, increases social support for staff and improves patient care.

Design
(1) A scoping review of Rounds literature and comparison with alternative interventions; (2) mapping Rounds providers via a survey, telephone interviews and secondary data; (3) a two-wave survey of (i) new attenders/non-attenders in 10 sites to determine the impact on staff engagement and well-being; and (ii) interviews with Rounds attenders, non-attenders, facilitators, clinical leads, steering group members, board members and observations in nine case study sites to (4) describe experiences and (5) test candidate programme theories by which Rounds ‘work’ (realist evaluation).

Setting
(1) International literature (English); (2) all Rounds providers (acute/community NHS trusts and hospices) at 1 September 2014 (survey/interview) and 15 July 2015 (secondary data); (3) 10 survey sites; and (4 and 5) nine organisational case study sites (six of which also took part in the survey).

Participants
(1) Ten papers were reviewed for Rounds and 146 were reviewed for alternative interventions. (2) Surveys were received from 41 out of 76 (54%) providers and interviews were conducted with 45 out of 76 (59%) providers. (3) Surveys were received from 1140 out of 3815 (30%) individuals at baseline and from 500 out of 1140 (44%) individuals at follow-up. (4 and 5) A total of 177 interviews were conducted, as were observations of 42 Rounds, 29 panel preparations and 28 steering group meetings.

Results
(1) The evidence base is limited; compared with 11 alternative interventions, Rounds offer a unique organisation-wide ‘all staff’ forum in which disclosure/contribution is not essential. (2) Implementation rapidly increased between 2013 and 2015; Rounds were implemented variably; challenges included ward staff attendance and the workload and resources required to sustain Rounds; and costs were widely variable. (3) There was no change in engagement, but poor psychological well-being (12-item General Health Questionnaire) reduced significantly (p < 0.05) in Rounds attenders (25% to 12%) compared with non-attenders (37% to 34%). (4 and 5) Rounds were described as interesting, engaging and supportive; four contextual layers explained the variation in Rounds implementation. We identified four stages of Rounds, ‘core’ and ‘adaptable’ components of Rounds fidelity, and nine context–mechanism–outcome configurations: (i) trust, emotional safety and containment and (ii) group interaction were prerequisites for creating (iii) a countercultural space in Rounds where staff could (iv) tell stories, (v) self-disclose their experiences to peers and (vi) role model vulnerability; (vii) provide important context for staff and patient behaviour; (viii) shining a spotlight on hidden staff and patient stories reduced isolation and enhanced support/teamwork; and (ix) staff learned through reflection resulting in ripple effects and outcomes. Reported outcomes included increased empathy and compassion for colleagues and patients, support for staff and reported changes in practice. The impact of Rounds is cumulative and we have identified the necessary conditions for Rounds to work.

Limitations
Rounds outcomes relied on self-report, fewer regular attenders were recruited than desired, and it was not possible to observe staff post Rounds.

Conclusion
Rounds offer unique support for staff and positively influence staff well-being, empathy and compassion for patients and colleagues.

A realist informed mixed-methods evaluation of Schwartz Center Rounds® in England

Triangulation: A Method to Increase Validity, Reliability, and Legitimation in Clinical Research.

Objectives (i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims, and compare effectiveness and key features to Rounds. Design Systematic review of Rounds literature; scoping reviews of comparator interventions (action learning sets; after action reviews; Balint groups; caregiver support programme; clinical supervision; critical incident stress debriefing; mindfulness-based stress reduction; peer-supported storytelling; psychosocial intervention training; reflective practice groups; resilience training). Data sources PsychINFO, CINAHL, MEDLINE and EMBASE, internet search engines; consultation with experts. Eligibility criteria Empirical evaluations (qualitative or quantitative); any healthcare staff in any healthcare setting; published in English. Results The overall evidence base for Rounds is limited. We developed a composite definition to aid comparison with other interventions from 41 documents containing a definition of Rounds. Twelve (10 studies) were empirical evaluations. All were of low/moderate quality (weak study designs including lack of control groups). Findings showed the value of Rounds to attenders, with a self-reported positive impact on individuals, their relationships with colleagues and patients and wider cultural changes. The evidence for the comparative interventions was scant and also low/moderate quality. Some features of Rounds were shared by other interventions, but Rounds offer unique features including being open to all staff and having no expectation for verbal contribution by attenders. Conclusions Evidence of effectiveness for all interventions considered here remains limited. Methods that enable identification of core features related to effectiveness are needed to optimise benefit for individual staff members and organisations as a whole. A systems approach conceptualising workplace well-being arising from both individual and environmental/structural factors, and comprising interventions both for assessing and improving the well-being of healthcare staff, is required. Schwartz Rounds could be considered as one strategy to enhance staff well-being.

https://bmjopen.bmj.com/content/bmjopen/8/10/e024254.full.pdf

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.

This paper examines general nurses’ views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses’ equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses’ ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards.

Record-keeping and routine nursing practice: The view from the wards

Purpose – This study explores how compassionate managerial leadership style can help to mitigate workplace stressors and alleviate stress experiences among employees — particularly in an extreme situation,
such as the current global COVID-19 pandemic. The study’s context is Nigeria’s banking, manufacturing and healthcare sectors, which have a history of high employee stress levels.

Design/methodology/approach – Using a qualitative, interpretive methodology, the study adopts the thematic analysis process (TAP) to draw and analyse data from semi-structured telephone interviews with 10
banking, 11 manufacturing and 9 frontline healthcare workers in Nigeria.

Findings – It was found that a compassionate managerial leadership can drive a considerate response to employees’ “fear of job (in)security”, “healthcare risk” and concerns about “work overload, underpayment and delayed payment”, which respondents considered to be some of the key causes of increased stress among employees during the current COVID-19 pandemic.

Research limitations/implications – The study is limited to exploring the relationship between compassionate managerial leadership and an organisation’s ability to manage employee stress in the COVID-19 situation, using 30 samples from organisations operating in three Nigerian cities and sectors. Future studies may involve more Nigerian cities, sectors and samples. It may also possibly include quantitative combination to allow generalisation of findings.

Practical implications – In order to survive in extreme situations, such as the COVID-19 pandemic, organisations are forced to take drastic and often managerialist-driven work measures which can trigger high
stress levels, low productivity and absenteeism among employees. Hence, organisations would benefit from implementing compassion-driven policies that are more inclusive and responsive to the workplace stressors
facing employees.

Originality/value – Employee stress has been widely explored in many areas, including definitions, stressors, strains, possible interventions and coping strategies. There remains, however, a dearth of scholarship on how management-leadership compassion can help to reduce employee stress levels in extreme conditions, such as the COVID-19 pandemic — particularly in emerging economies.

/pdf/exploring-compassionate-managerial-leadership-style-in-2digh6tl0o.pdf

Exploring compassionate managerial leadership style in reducing employee stress level during COVID-19 crisis: the case of Nigeria

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, discusses the retention of nurses and examines the evidence available that reveals the root of the problem and possible solutions

Making retention strategies work

Sam Foster, at time of writing Chief Nurse at Heart of England NHS Foundation Trust, considers the implications for patient outcomes of implementing safety huddles.

Implementing safety huddles.

This article explores how Heart of England NHS Foundation Trust has increased its capacity to provide credible data to show how care is delivered. The trust developed its own evaluation methods using the triangulation process, which measures the same outcomes through different methods or sources and compares the results to see if they offer the same or similar conclusions. See also case study on page 20.

Triangulating data to improve care.

Schwartz Rounds: our experience

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, discusses how attitudes to leadership styles have changed and reflects on the role of compassionare leadership in improving care

Compassionate leadership counts

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