Tara Lamont: Support through sharing stories

Tara_Lamont_3It seems like it really is good to talk. A new study by Jill Maben carefully evaluated the experience of nurses, doctors, and others taking part in Schwartz Rounds. These were introduced to the UK ten years ago from the US, offering a safe, facilitated space for staff (clinical and non-clinical) to share stories about caring for patients, especially when this has been difficult. More than 150 NHS organisations now offer these rounds. The research, funded by the National Institute for Health Research (NIHR), found attending regularly improved the mental wellbeing of staff. 

Perhaps this is not surprising. Viewers of recent high quality documentaries, from Hospital to Junior Doctor, often express amazement at the emotional (and physical) burdens placed on frontline staff in a typical day. Yet there has not always been enough attention given to how this affects people and what support they need. Schwartz Rounds are distinct in being open to all staff in an organisation and focused on supporting staff, rather than solving problems (as with other workplace forums).

That said, some precursors do exist. These range from Balint groups—set up in the 1950s by a psychotherapist to support general practitioners by discussing case stories which were distressing—to action learning sets.

There are also parallels with mortality and morbidity meetings. Indeed, there is a small, but fascinating literature on these reflective spaces for doctors. This includes Charles Bosk’s seminal work on surgical error in the 1970s, using deep ethnography to uncover the ways in which these meetings helped to socialise trainees into the culture of surgery. It also showed the importance of senior clinician’s role modelling open discussion of things that go wrong and how it felt.

When I worked at the National Patient Safety Agency, one of our most downloaded reports was Medical Error.

This featured first-hand accounts by medical leaders of mistakes, from giving ten times too much heparin to a child to missed diagnoses. Many of these errors happened early in their career, but haunt them still. These testimonies are important—and why, in safety circles, staff are known as the “second victims” when mistakes happen. 

It makes sense that in order to care for patients well, staff need to be looked after themselves. Schwartz Rounds enable this to be done in a structured way, but need careful planning and facilitation to make it work well. In this country, organisations wanting to introduce Schwartz rounds can find support here. It seems that sharing stories about difficult encounters can help staff feel better—and build resilience to carry on caring.

Tara Lamont is deputy director of the NIHR Dissemination Centre. The views expressed here are her own.

Competing interests: None declared.