Supporting senior leaders through Schwartz Rounds
01 September 2020
Bev Fitzsimons writes about new findings on how executives experience Schwartz Rounds.
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Schwartz Rounds are a group reflective practice which gives an opportunity for staff from all disciplines to reflect on the emotional aspects of their work. Within a Round, three or four carefully prepared panellists share a story related to the theme of the Round. Following that, the Round is opened to the reflections of the audience more widely. It is a forum for sharing experiences rather than solving problems or questioning panellists.
Research has shown that healthcare staff who regularly attend experience less psychological distress, improved teamwork and increased empathy and compassion for patients and colleagues. But do they work well for leaders in organisations?
Myers, Lal and Goodrich (2020) undertook a qualitative research study to explore this question. It was based on interviews with 25 senior leaders who have experienced Schwartz Rounds. They found that Rounds are viewed by senior leaders as a positive organisational intervention, akin to “hearing the organisation”.
They attend Rounds to show visible support and set an example, and to show that Rounds are valued by the senior team. Senior leaders felt personal benefit of attending Rounds, reporting that it helped them keep in touch with the organisation, to stay grounded, and to understand the work of different staff, which they felt contributed to doing their jobs better.
Although some talked of reconnecting to their mission, some senior leaders didn’t necessarily see that there was the same personal benefit to them attending Rounds as for other staff. This stemmed from their strong feelings of responsibility for what they were hearing during Rounds, which could provoke feelings of discomfort, vulnerability, anxiety, and powerlessness. Executives also spoke of feeling self-conscious in Rounds, due to their role, and a concern that sharing their emotion might undermine their credibility. They felt the need to protect staff, by suppressing their feelings.
For some, the Rounds had the effect of increases in stress and anxiety, which is a striking contrast to the findings of the national evaluation of Schwartz Rounds. This is likely due to the feelings of personal responsibility for what is heard in Rounds. One of the strongest themes was that the execs feel that the Rounds are not designed for their benefit, or even that they do not expect to benefit from them in the same way as the staff who do not occupy executive roles.
Regardless of position, there is value in Schwartz Rounds for everyone’s personal wellbeing. However, we acknowledge that not all staff can access Rounds equally, for a variety of reasons. This research is useful in telling us that we need to think differently about how this group of staff can access Rounds. In part, this might be about them accessing Rounds together as a group and reflecting with them on the nature and challenges of leading with compassion and the part that practising self-compassion can play in this.
Schwartz Rounds are often described as a leveller of hierarchies. Yet the leaders in this study were so conscious of being leaders that they felt unable to expose themselves in the same way as other staff. There is no one “right” approach to this issue – some leaders may be more able to show vulnerability than others, and there may be a need to provide specific support in this area.
We know from Rounds run in many places that staff respond well to seeing the vulnerability and humanity in their leaders, and while we accept that there are genuine anxieties felt by execs, we wonder whether leaders feel undue pressure to “keep up appearances”.
The covid pandemic has led us to develop a far greater range of online interventions for NHS staff, and this raises the question of whether an online forum specifically aimed at executives could make a difference to those expressing these concerns.
The Point of Care Foundation will be piloting Schwartz Rounds for Execs in Autumn 2020, inviting executives from the organisations that are part of Schwartz community to join online Rounds. These will be facilitated by execs who are experienced as both panellists and participants and who will have insight into their concerns. These will be in addition to the Rounds taking place inside participants’ own organisations: the fact that Rounds are organisation-wide is integral to their ethos.
These Rounds aim to provide an opportunity not just to reflect on the emotional and social response to the work experiences of leaders but also the reasons for “keeping up appearances”.
We will be evaluating whether such an approach can alleviate some of the anxieties described and offer the benefits to psychological wellbeing that have been demonstrated elsewhere, and build the confidence of execs to participate more fully in Rounds in their own organisations.
This article was originally published in Health Service Journal.
Update (15th March 2021): this work is now also featured in a Nursing Times article.