Staff wellbeing and quality improvement: a virtuous circle

Dr Jocelyn Cornwell profile picture

20 May 2019

Dr Jocelyn Cornwell
Chief executive
Point of Care Foundation


The forthcoming Quality Conference organised by NHS Providers will look at the role of boards in developing a strong safety culture and driving quality improvement. I am pleased to have been invited to speak about Schwartz Rounds at the event, as part of a session looking at why support for staff and quality improvement work are complementary activities.

On the face of it, there may not seem to be a connection between the two objectives, but they are in fact deeply related. Schwartz Rounds are a forum for healthcare staff to come together and reflect on the emotional and psychological aspects of their work, which has direct, positive benefits for staff morale and wellbeing. Independent evaluation shows that the impact on the individual of participation in Schwartz Rounds is strong, with regular attendees reporting half the incidence of psychological distress of their non-attending colleagues.

The latest NHS staff survey data, published in February, illustrate just how much wellbeing initiatives are needed. The figures show fewer than 30% of staff reporting that their organisation takes positive action on health and wellbeing. Stress levels are the worst the survey has found in five years, with almost 40% of staff reporting feeling unwell as a result of work related stress in the past year. More than half of survey respondents said they went to work despite not feeling well.

Schwartz Rounds help people to sustain their humanity amidst the many day-to-day challenges that they are encountering.

Dr Jocelyn Cornwell    Chief executive

Against this backdrop, it would be reasonable to argue that a forum that gives staff the chance to spend time with colleagues from all disciplines, to share and listen to stories about what it is to work in the NHS, must be welcome. Schwartz Rounds help people to sustain their humanity amidst the many day-to-day challenges that they are encountering.

But the conference next month is about quality of care, so how does a ‘staff wellbeing’ intervention like Schwartz Rounds fit in? There is more to the idea of providing a forum for staff to reflect together than simply looking after staff – important though that is. The bigger prize is the knock-on effect that staff wellbeing has on patients, on their experience of care and on care quality. Research into Rounds has shown that, quite apart from the benefits felt by individual participants, ‘ripple effects’ from Schwartz Rounds are felt throughout organisations, changing conversations, increasing understanding between groups of staff, and increasing empathy for patients and colleagues. At the Point of Care Foundation, therefore, we see Schwartz Rounds as integral to the work of improving care quality.

There is more to the idea of providing a forum for staff to reflect together than simply looking after staff – important though that is. The bigger prize is the knock-on effect that staff wellbeing has on patients, on their experience of care and on care quality.

Dr Jocelyn Cornwell    Chief executive

Other aspects of our work have a different focus but work to achieve the same ends. For example, we provide training in patient-focussed quality improvement methods, through our ‘Sweeney programme. The approach takes patients’ experiences as its starting point, working with clinical teams and teaching them how to apply tools and techniques that show them what it is like to be a patient in their service, and how to use those insights to change the way care is delivered.

We would argue, therefore, that all aspects of our work – even those that are focused on staff wellbeing – are directed at care quality. However, quality improvement that starts with a focus on patients and actively involves them in the change process, has the effect of freeing healthcare professionals up to look afresh at the care they provide – and actually has as great an impact on the staff as it does on patients. The improvements are felt by patients and their families, but they also liberate staff. Teams we work with report that the work of patient-centred quality improvement is satisfying because it reconnects them with the intrinsic motivation to care for people that brought them into the caring professions.

While staff wellbeing feeds into the quality of care for patients, care quality improvement, done well, also impacts on staff wellbeing.

Dr Jocelyn Cornwell    Chief executive

So it works both ways. While staff wellbeing feeds into the quality of care for patients, care quality improvement, done well, also impacts on staff wellbeing.

Schwartz Rounds, which I look forward to discussing more at the conference next month, are a terrific way to help staff to rediscover their humanity, which is so often lost in the daily grind of work in the challenging environments of healthcare. But they are about so much more than staff wellbeing. The links between staff and patient welfare are many and complex, but we see evidence of a virtuous circle fuelled by the two.

About the author

Dr Jocelyn Cornwell profile picture

Dr Jocelyn Cornwell
Chief executive

Jocelyn is the founder and chief executive of The Point of Care Foundation, an independent charity that aims to humanise health and care services and improve the experiences of both patients and staff. Jocelyn’s original training was as a medical sociologist and anthropologist. Her PhD thesis, an ethnographic study of beliefs about health and illness in East London, was published as 'Hard-Earned Lives' by Tavistock Press in 1984. In the course of her career she has worked in universities and the NHS and for the Audit Commission, the Department of Health and the Commission for Health Improvement (CHI).
She is a trustee of the Nuffield Trust.

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