Schwartz Rounds Enhancement of Institutional Communication

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Schwartz Rounds Enhancement of Institutional
Communication

• Martha Jurchak
• Brigham and Womens Hospital
• Marjorie Stanzler
• The Schwartz Center
• Lynn Nichols
• Brigham and Womens Hospital/ The Schwartz
  Center

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Schwartz Center Rounds
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Purpose

• Multidisciplinary forum
• Discuss difficult emotional and social issues
  inherent in patient care
• Different from clinical or ethics rounds
• Supports caregivers in their difficult and
  stressful roles

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Expansion

• Currently in 100 sites in 25 states
• Very successful
• Caregivers appreciate the opportunity
• Schwartz Center responding to calls from all over
  the US
• Also targeting certain hospitals in NYC,
  Philadelphia and Washington, DC

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Format

• Based on specific patient case
• Identified topic for discussion
• Examples
• non-compliant patient
• caring for a colleague
• team conflict around treatment plans
• Panel of caregivers describe their experience
  with patient (10-15 minutes)
• Remainder of hour devoted to discussion among
  attendees
• Share experiences, thoughts and feelings
• Confidentiality maintained
• Can be based in specific area (e.g., cancer
  center) or done hospital-wide

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Benefits

• Caregivers realize not alone
• Enhances communication and sense of community
  among caregivers
• Improves communication with patients and families
• Gain appreciation for knowledge and expertise of
  colleagues from different disciplines
• Conducting comprehensive quantitative and
  qualitative evaluation

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In Caregivers Own Words

• Rounds are a place where people who don't
  usually talk about the heart of the work are
  willing to sharetheir vulnerability, to question
  themselves. Rounds are an opportunity for
  dialogue that doesn't happen anywhere else in the
  hospital.

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Testimonial

• They have given me permission to count on the
  team more than I did at the beginning, knowing
  that there are many different people on the team
  with different roles. For families that I could
  not connect with, I knew there was someone else
  who could.

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Testimonial

• The Rounds celebrate the humanity of all of us.
  To hear docs or chaplains not have the answer is
  helpful. We often think someone else has the
  answer. As people do this work longer, we have
  to be at peace with not knowing everything and it
  is affirming to see people with different lengths
  of experience giving feedback and support. We
  aren't alone in the struggle.

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Testimonial

• This is such hard workRounds are a place to
  come together and share support and validation
  for one another. It meets a deep need that we
  wouldn't have even known to ask for. It fulfills
  a hole in the clinical community.

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Staff

• Physician leader
• Facilitator (usually from outside the hospital)
• Planning group
• 8-10 caregivers multidisciplinary
• Publicize Rounds
• Plan topics and presenters
• Administrative assistant handles logistics

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Costs

• Schwartz Center pays for food and outside
  facilitator
• Hospital absorbs incidental expenses and time of
  staff involved in planning

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Credits

• CME for physicians
• CEUs for nurses and social workers
• Helps satisfy ACGME communications requirements
  for residents
• JCAHO

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The Impact of Schwartz Rounds on Institutional
Communication

• Or Whos Listening?

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Schwartz Rounds at Brigham and Womens Hospital

• First Rounds were in 2002
• Advisory Board made up of 17 hospital staff
  members physicians, nurses, social workers,
  clergy, patient relations

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Schwartz Rounds Topics at BWH

• 2004-2005
• When clinicians become patients
• Compassion fatigue
• Communication and adverse events
• Culture and religion in end-of-life care
• Addressing patients spiritual needs
• Compassionate care and heart failure

• 2005-2006
• Clinical narratives and patient care
• Multidisciplinary care in the NICU
• Compassion for colleagues in trouble
• Race and ethnicity, the providers perspective
• Technology and decision making
• Easing the burden of family decision making

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What are the Hidden Messages of Schwartz Rounds?

• It is OK to respectfully disagree
• We dont always do the right thing, but we learn
  from it and move along
• Each member of the multidisciplinary team makes a
  valued contribution
• Its important to care for patients and for one
  another
• The hospital leadership values these things

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What Does Schwartz Rounds Do?

• Sets an example
• Provides a simulation for how to handle difficult
  situations
• Shows theres an evolution to the conversations
  vicarious understanding

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For Us, Transparency is a Major Cultural Change

• What does it sound like?
• Are there success stories?
• What does it feel like?

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What Do the Risk Managers Say?

• For someone new to the institution, it taught me
  the culture of the institution.
• I go whenever I can because the stories are so
  interesting and I always learn something.
• Seeing the rank and file in conversation with
  department heads and physicians is so important.