Richard Smith: Support for health and social care staff

Health and social care staff are under enormous strain. The weekly clap and being given priority in shops is much appreciated, but how can more direct, practical, and evidence-based emotional support be provided?

The Point of Care Foundation (of which I’m the unpaid chair) has been providing such support for years—mainly through Schwartz Rounds, which were developed in the United States and are regularly used in some 200 health and social care organisations in the UK and Ireland. They are hour-long confidential meetings of all staff who are interested. They are facilitated and comprise three volunteers telling stories of difficulties and then everybody reacting to the stories, perhaps by sharing their own experiences. They are not about either problem-solving or blaming, but about reflection, sharing, and support. The National Institute for Health Research funded a review of ways of supporting staff emotionally and concluded that Schwartz Rounds had the strongest evidence base.

Schwartz Rounds are not suitable for support during the pandemic because they depend on a large group meeting together and volunteers share experiences that happened months or years ago and are not too emotionally raw.

Recognising the great current need for support, the Point of Care Foundation has come up with Team Time, a new method of support that uses some of the ideas of Schwartz Rounds but with extra safety features. They are shorter (45 minutes), happen online with only the two facilitators and two (not three) storytellers visible, and are restricted to 30 people from the same team. The Point of Care Foundation trained facilitators for Team Time and then piloted it. It’s now being used in the NHS.

I’ve attended and written about Schwarz Rounds, but I couldn’t attend a live meeting as I would be an intruder on a team—but I could watch the pilot, which was attended by volunteers from several institutions.

The session began with the facilitators describing the nature of Team Time, and then a NHS psychologist told how she had had to self-isolate. She joined work meetings online and saw how tired and drained her colleagues looked, felt bad that she was working at home, and wondered how she could help more. She didn’t like the constant military talk of battles, frontlines, surges, and defenses. At the same time she was hearing unbearable stories of illness in people close to her, some of whom had died. She was close to feeling overwhelmed when she saw her teenage daughter who was having a tantrum over a minor domestic matter. The storyteller took a breath and managed to hug her daughter and say “We are all doing the best we can.”

A surgeon, who was also having to self-isolate and had had colleagues die, described how she worked with a team within a network that had tensions. The network had established a WhatsApp group, which worked well, but one day one of the other surgeons on the network made a derogatory remark about the storyteller’s team. The storyteller was distressed and pointed out the remark to the person who had made it, who immediately apologised. There is, said the storyteller, “so much distress” and we must “be kind to each other.”

Everybody was on mute apart from the person speaking, and people indicated that they wanted to speak by using the chat function. Almost everybody began by saying “can you hear me?” and I imagine that people will drop that as they get used to online meetings. When I attended Schwartz Rounds there were often pauses before people spoke, but here there were no pauses between speakers. Everybody thanked the storytellers for being brave enough to share their stories, and there were many mentions of “sharing” and of there being “strength in vulnerability.”

One man talked about it being hard to manage the wait for something to happen. Many people talked of being scared and those who had had to self-isolate described a feeling of helplessness. A recurrent theme was the difficulty of “switching off” at home, the increased difficulty of separating work and home, and the worry of infecting family members. One woman described how her seven-year-old daughter kept telling her she was “staring again.” People spoke of “being at war,” and one man compared the pandemic to “9/11 and the aftermath,” only then the main worry was about the past, whereas now it was about the future.

People were asked to feedback after the session not with a survey but in their own words in answer to open questions. I’ve read through all the feedback and it was almost all positive, although it had made people feel emotional. 

  • “I found the session very powerful. Similar to Schwartz Rounds I felt “safe” and able to communicate my (strong) feelings on the issues being raised.”
  • “I found the session very powerful and I was surprised how much it made me reflect on my own feelings both then and now, whilst that was difficult I think it was really valuable.”
  • “Emotional, a good way for me to connect with myself and others, feel less alone with my reactions to the crisis, shared humanity.”

The Point of Care Foundation has modified the process by allowing people to use platforms other than Zoom and teams to choose to have everybody visible. Between 17 and 24 April the Foundation team trained 430 people from 140 organisations in 39 sessions, and many of those people have run or are about to run sessions. The individuals attending training were already trained in Schwartz Rounds facilitation, so already had a solid grounding in the Schwartz process. This also helped implement the adaptation in a safe way. The Foundation will continue to monitor how Team Time is used and modify it further if necessary.

Richard Smith was the editor of The BMJ until 2004.

Competing interest: RS is the unpaid chair of the Point of Care Foundation. His daughter started work as an “interim-F1” doctor working on an acute medical ward two weeks ago.