Do Schwartz Center Rounds® Hold Transformational Power? An Investigation into the Subjective Experiences of Panellists in Devon.
Morris, Lisa Marie
Thesis or dissertation
University of Exeter
Reason for embargo
The embargo is for a standard period of 18 months to prepare papers for publication using material that is substantially drawn from the thesis.
Systematic Review: The Impact of Schwartz Center® Rounds and Reflective Practice Groups on Healthcare Teams: A Systematic Literature Review. Abstract. Background: Schwartz Center Rounds® (SCRs) are multidisciplinary reflective forums where healthcare staff can discuss the psychological and emotional impact of work. Two NHS trusts piloted SCRs in 2009. They now run in 150 UK sites to support staff and enable compassionate care. The investment into SCRs has not been evidence-based. Early studies indicating positive outcomes for healthcare teams at individual, relational, and organizational levels were criticized for lacking rigour. Reflective practice groups (RPGs) share similarities with SCRs but pose a lighter burden on resources. No systematic reviews have investigated the outcomes of these interventions. Therefore, it was important to consider the evidence for both. Objective: To investigate the impact of SCRs and/or multidisciplinary RPGs on healthcare teams on individual, relational, and organizational levels. Method: Qualitative, quantitative, and mixed-methodology empirical studies and autoethnographic evidence on SCRs and/or multidisciplinary RPGs were sought via PsycINFO, Scopus, and Web of Science, The Point of Care Foundation evidence library, the Journal of Compassionate Health Care, and from two recent SCRs studies’ investigators. Results: The search yielded 863 records; 83 were fully accessed and 21 included. The studies’ quality was variable. All matched PICOS criteria and were maintained. Discussion: Four themes were identified: 1. Reflection, learning, and development; 2. Emotional and psychological impact; 3. Storytelling: Connecting humans through narrative communication; 4. Leadership and culture: Openness and honesty. Enablers and barriers, specifically, resources and safety, were connected to, and discussed within, theme four. Conclusions: SCRs and RPGs showed positive effects on healthcare teams at all levels. RPGs may be more conducive to establishing safety; SCRs held greater potential for staff to develop more holistic perspectives with opportunities for dialogue to effect organizational changes. The findings should be treated with caution given the potential bias of many participants and authors and the dearth of SCRs/RPGs’ non-participants’ perspectives. Whether SCRs have the power to effect sustained organizational change has yet to be established. Keywords: Schwartz Center Rounds, Reflective Practice Groups, healthcare teams, compassion Empirical Paper: Do Schwartz Center Rounds® Hold Transformational Power? An Investigation into the Subjective Experiences of Panellists in Devon. Abstract. Objective: To investigate the subjective experiences of NHS Schwartz Center® Rounds (SCRs) panellists in Devon. To explore whether SCRs hold transformational power on three levels: individual, (group/self-other) relational, and organizational, within an overarching systemic approach. Data sources/study setting: Twelve panellists who had presented at the Royal Devon and Exeter NHS Foundation Trust-Devon Partnership NHS Trust (RD&E-DPT) SCRs in South West England, the first joint SCRs initiative between an acute NHS trust (RD&E) and a mental health NHS trust (DPT). Six RD&E and six DPT panellists took part between May and November 2016, who were also regular attendees (N=4), non-regular attendees (N=5), and non-attendees (N=3) of SCRs. Study design: Twelve individual semi-structured qualitative interviews. Data analysis: Thematic analysis from a social constructionist position was employed to identify patterns across the data set. Key findings: The analysis identified three overarching themes: 1. Psychological safety, culture/s, and leadership; 2. Reflection, learning, and development; 3. Storytelling, connection, and compassion. Reciprocal relationships appeared mutually reinforcing amongst these interacting themes. SCRs in this context appeared to effect transformation at individual and relational levels, with limited impact at the organizational level. For most participants, relational changes were around increased human connection, compassion, and empathy towards colleagues rather than patients. Conclusions: SCRs’ transformational power may be constrained if organizations are solely focused on achieving external goals and if barriers, particularly related to psychological safety, cultural assumptions, norms, and values, are not addressed. Possible SCRs’ mechanisms cited by previous research were supported and a new theoretical model proposed. Key words: Schwartz Center Rounds, compassion, empathy, staff support, human.
Doctor of Clinical Psychology