Supporting senior leaders through Schwartz Rounds

Bev Fitzsimons profile picture

02 October 2020

Bev Fitzsimons
Director
Point of Care Foundation


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. However, do they work well for leaders in organisations?

A 2020 qualitative research study explored this question. The research 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 also 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.

Bev Fitzsimons    Director

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 increased 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 executives 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.

Schwartz Rounds are often described as a leveller of hierarchies. Yet the leaders in this study were so conscious of being leaders, they felt unable to express 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.

Bev Fitzsimons    Director

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 executives, we wonder whether leaders feel undue pressure to ‘keep up appearances’.

The COVID-19 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 running a Schwartz Round for executives at NHS Providers’ annual conference and exhibition. The round titled Being in charge but not being in control, will be facilitated by experienced Schwartz Facilitators.

This rounds aims 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’.

About the author

Bev Fitzsimons profile picture

Bev Fitzsimons
Director

Bev is the director of the Foundation, as well as being responsible for the development, design and oversight of patient-centred quality improvement initiatives.

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