Effectiveness of a group intervention to reduce the psychological distress of healthcare staff: a pre-post quasi-experimental evaluation.

BACKGROUND: Work stress and compassion fatigue are prevalent among healthcare staff and their negative effects on staff well-being and patient care are well-known. This paper reports on the implementation and evaluation of Schwartz Rounds® (Rounds) in UK healthcare organizations, predominantly part of the National Health Service (NHS). Rounds are one-hour, typically monthly, multidisciplinary forums during which clinical and nonclinical healthcare staff discuss the emotional and social demands of delivering patient care. The purpose of this research was to evaluate the effectiveness of Rounds attendance on the psychological distress, work engagement, compassion and self-reflection of healthcare staff. METHODS: We used a pre-post control design to assess the effect of Rounds attendance across 10 UK healthcare organizations. This design was most appropriate given the voluntary nature of Rounds and ensured the study had ecological validity. Self-reported data were collected from attenders and non-attenders at baseline and at eight-months follow-up. The outcomes were psychological distress, work engagement, compassion and self-reflection. RESULTS: During the 8 months' study duration, regular attenders (N = 51) attended Rounds on average 4 times (2-8). Attenders showed a significantly greater decrease in psychological distress (as measured with the General Health Questionnaire (GHQ)) than non-attenders (N = 233; odds ratio of 0.197; 95% confidence interval (0.047-0.823)). However, Rounds attendance had no significant effect on work engagement, compassion and self-reflection. CONCLUSIONS: Rounds attendance was linked to a 19% reduction in psychological distress adjusting for covariates. As an organization-wide intervention, Rounds thus constitute an effective, relatively low-cost intervention to assist staff in dealing with the demands of their work and to improve their well-being.

'We needed to talk about it': The experience of sharing the emotional impact of health care work as a panellist in Schwartz Center Rounds® in the UK.

OBJECTIVES: Schwartz Center Rounds® ('Rounds') are multidisciplinary forums where health care staff come together to reflect upon the emotional impact of their work. In each Round, a small number of staff (panellists) share experiences through stories to trigger reflection in audience members. Previous research has identified impacts associated with Rounds' attendance, but little is known about the experience and impact of Rounds from panellists' perspectives. This study is the first to explore the role of disclosure and reflection through storytelling in Rounds, specifically exploring panellists' motivations, experiences and reported impacts associated with panel participation. METHODS: Interviews with 50 panellists, from nine case-study sites in the United Kingdom, representing acute, community and mental health National Health Service trusts and hospices. Data were analysed using thematic analysis. RESULTS: Most panellists spoke positively about their experience of sharing their stories in Rounds. Reported impacts included: increased emotional resilience and acceptance of experiences; reduced negative assumptions about colleagues and increased approachability and trust increasing tolerance and compassion; the creation of a space to stop and think and to reframe negative patient experiences facilitating greater empathy and emotional disclosure becoming more visible and normative, thereby helping change culture. Impacts on staff were similar regardless of contextual variability, including their professional group or role, with the exception of impact on patient care, which was not mentioned by non-clinical staff. The extent of panel preparation and audience characteristics (e.g. size, composition and response to their stories) influenced panellists' experiences and outcomes. CONCLUSIONS: Rounds highlight the important role of disclosure and reflection through storytelling to support panellists with the emotional aspects of their work, providing a space for support with the emotional demands of health care, reducing the need for employees to be stoic. Panel participation also offers an important source of validation in organizations marked by scrutiny.

The embodiment of a floating signifier.

As described in ethnographies, the 'floating signifiers' of social anthropology appear akin to similar categories in contemporary Western societies such as energy. Both may be embodied in actual experience. The practice of ritual orgasm, Pra-Na, and its relation to the group's cosmology, are intrinsic to a religio-therapeutic community in San Francisco whose ideas derive from reified Western notions of 'vital energy' along with popular Chinese medicine, and in which the second author conducted fieldwork involving participant observation between 2008 and 2009. The article examines closely the formulations of 'energy' in the Western world, and similarities to non-Western concepts such as Melanesian mana, and asks whether the experience of ritualised orgasm by members of the group leads to their notion of cosmic energy, or whether the understanding of embodied energy is purely arbitrary from a somatic perspective. With reference to Durkheim's ([1912]1976. The Elementary Forms of the Religious Life. London: Allen & Unwin) -effervescence, we suggest the former is most likely.

The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds® from the United States to the United Kingdom.

BACKGROUND: Schwartz Center Rounds® (henceforce Rounds) were developed in the United States (US) in 1995 to provide a regular, structured time and safe place for staff to meet to share the emotional, psychological and social challenges of working in healthcare. Rounds were adopted in the United Kingdom (UK) in 2009 and have been subsequently implemented in over 180 healthcare organisations. Using Rounds as a case study, we aim to inform current debates around maintaining fidelity when an intervention developed in one country is transferred and implemented in another. METHODS: Interpretive design using nine qualitative interviews (UK = 3, US = 6) and four focus groups (UK: Focus group 1 (4 participants), Focus group 2 (5 participants; US: focus group 1 (5 participants) focus group 2 (2 participants) with participants involved in Rounds design and implementation, for example, programme architects, senior leaders, mentors and trainers. We also conducted non-participant observations of Rounds (UK = 42: USA = 2) and training days (UK = 2). Data were analysed using thematic analysis. RESULTS: We identified four core and seven sub-core Rounds components, based upon the US design, and seven peripheral components, based on our US and UK fieldwork. We found high core component fidelity and examples of UK adaptations. We identified six strategies used to maintain high fidelity during Rounds transfer and implementation from the US to UK settings: i) having a legal contract between the two national bodies overseeing implementation, ii) requiring adopting UK healthcare organisations to sign a contract with the national body, iii) piloting the intervention in the UK context, iv) emphasising the credibility of the intervention, v) promoting and evaluating Rounds, and vi) providing implementation support and infrastructure. CONCLUSIONS: This study identifies how fidelity to the core components of a particular intervention was maintained during transfer from one country to another by identifying six strategies which participants argued had enhanced fidelity during transfer of Rounds to a different country, with contractual agreements and legitimacy of intervention sources key. Potential disadvantages include limitations to further innovation and adaptation.

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.

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.

Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015.

OBJECTIVES: Schwartz Center Rounds ('Rounds') are a multidisciplinary forum in which healthcare staff within an organisation discuss the psychological, emotional and social challenges associated with their work in a confidential and safe environment. Implemented in over 375 North American organisations, since 2009, they have been increasingly adopted in England. This study aimed to establish how many and what types of organisations have adopted Rounds in England, and to explore why they did so. SETTING: Public healthcare organisations in England. PARTICIPANTS: Secondary data analysis was used to map and profile all 116 public healthcare organisations that had adopted Rounds in England by July 2015. Semistructured telephone interviews were conducted with 45 Round coordinators within adopting organisations. RESULTS: The rate of adoption increased after a major national report in 2013. Rounds were typically adopted in order to improve staff well-being. Adopting organisations scored better on staff engagement than non-adopters; among adopting organisations, those performing better on patient experience were more likely to adopt earlier. Most adoption decision-making processes were straightforward. A confluence of factors-a generally favourable set of innovation attributes (including low cost), advocacy from opinion leaders in different professional networks, active dissemination by change agents and a felt need to be seen to be addressing staff well-being-initially led to Rounds being seen as 'an idea whose time had come'. More recent adoption patterns have been shaped by the timing of charitable and other agency funding in specific geographical areas and sectors, as well as several forms of 'mimetic pressure'. CONCLUSIONS: The innate attributes of Rounds, favourable circumstances and the cumulative impact of a sequence of distinct informal and formal social processes have shaped the pattern of their adoption in England.

'Pass the Cream, Hold the Butter': Meanings of HIV Positive Semen for Bugchasers and Giftgivers.

It has been argued by some that sexual health campaigns' ignorance of the richness of meanings associated with semen for gay men has actually led to an increase in the spread of HIV/AIDS(Rofes 1996 ). This paper reviews some of these meanings and their employment among a group of gay men who actively want to be infected with HIV as well as wanting to infect others ('bugchasers' and 'giftgivers'). Based on the analysis of exchanges posted on a website used by bugchasers and giftgivers, this research asks if the attitude towards semen of men who apparently actively seek and spread HIV infection, an extreme act, would be equally extreme. It attempts to show that despite the extreme negativity and apparent sexual transgression engaged in by these men, their conceptions of what semen is and does is quite normative-semen causes pregnancy. These findings illustrate both that semen has the same richness of meaning for gay men as for the heterosexual population. Therefore, semen's meanings cannot be ignored when attempting to educate men about sexual practices. Bugchasing and giftgiving as behaviours and discourse that employ HIV infected semen containing the men's DNA are a way of overcoming the sense of isolation that results from 'cold, sterile', protected sex, despite their initial appearance as abject, transgressive and destructive.