Stress in NHS staff triggers defensive inward-focussing and an associated loss of connection with colleagues: this is reversed by Schwartz Rounds

Abstract

The aim of this case study was to examine the impact of Schwartz Rounds on staff wellbeing and patient care. A series of interviews were conducted with staff, regarding stress. The key themes, which were extracted using Grounded Theory, were used to inform the development of a new measure, ‘The Organizational Response to Emotions Scale’. This was administered at the beginning and end of Schwartz Rounds. Analysis of the results revealed a significant reduction in attendees’ appraisal of emotional labour and an increase in reflection. This was associated with a reported upsurge in feelings of interconnectivity and compassion towards colleagues. More traditional forms of individualised staff support were in contrast, viewed as unhelpful. In particular, the offer of counselling sessions was resented by many staff because it carried the implicit message that the problem arose from a deficiency or weakness within them. New performance management policies compounded this problem and left many feeling blamed and punished for their stress. A referral to Occupational Health was widely seen as an index of failure; a sign that they could not cope. Attendance at the Schwartz Rounds helped staff to recognise that their feelings were normal in the context of a highly-pressured healthcare system. Eradicating the stigma associated with emotional responses should help to improve organizational culture. It may also help to address an emerging phenomenon that was identified within this study, namely that staff had begun to hide their feelings from their managers. In the longer term, this could serve to mask the true extent of stress and burnout within the NHS. The findings suggest that Schwartz Rounds may indirectly improve the quality of patient care by addressing the stress-induced cognitive narrowing and decline in empathy that precedes withdrawal; the process that is a likely forerunner of dehumanization. An additional finding was that the line manager played an important mediating role of containment. This, in turn, appeared to influence the level of support that staff provided to each other.