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May The Schwartz Be With You: Fostering Ethical Care Environments through Schwartz Rounds— A Live Demonstration


Paula Goodman-Crews, LCSW; Deborah Kasman, MA, MD; Felicia Cohn, PhD


Abstracts from the Kaiser Permanente 2018 National Quality Conference

From Southern California

Background: The Schwartz Rounds (SRs) facilitated interdisciplinary discussion fosters open dialogue about social, emotional, and ethical issues that arise in patient care. Attending SRs regularly has been shown to increase compassion, improve teamwork, offer new strategies to address challenging cases, and increase sense of belonging, which also is associated with lower employee turnover. Employee and caregiver experiences drive patient experiences; hence when health care staff experience compassion in the workplace, they in turn deliver more compassionate care. Compassionate care has been linked to better outcomes including reduction in costs and higher patient satisfaction.
Methods: Population: All Medical Center staff are invited to attend SRs to derive the benefit of improved compassion and teamwork, increased understanding of patient experience, and experience of different disciplines. Intervention: One-hour discussion facilitated by a trained individual. Each SR begins with four-minute narratives of three panelists who were directly involved in a challenging case and talk about the emotions generated. Narratives serve as a catalyst to engender similar narratives amongst attendees. Comparison: There are no metrics to discern experience of Medical Centers not offering SRs. Outcome measures: The Schwartz Center obliges contract Medical Centers to evaluate attendee experience, thus evaluations are completed after each SR.
Results: Kaiser Permanente Medical Centers currently offering SRs have reaped its benefits with more than 95% of participants gaining new insights into patient and family perspectives, and those of coworkers; more than 93% being more open to collaboration with colleagues; 83% feeling less isolated; and 97% planning to attend SR again. Most Medical Center SRs draw from 40 to 100 participants. Kaiser Permanente Southern California aggregate evaluations from 2015 demonstrates that regular attendance at SRs increases compassionate patient care; promotes self-care; improves teamwork; offers strategies to deal with challenging cases; and increases a sense of belonging, which can decrease employee turnover.
Discussion: Burnout rates of physicians are at an all-time high, rising to a mean of 55% across all physician specialties, which is a 10% rise in just 3 years. Nurses are experiencing rapidly rising rates from compassion fatigue and burnout as well. Building resilience amongst our health care providers facilitates better ability to cope with the psychosocial demands of care and perceived stress of care. Having SRs at our Medical Centers has helped our practitioners address the psychosocial demands of care, thereby fostering an improved ethical environment of care.

Abstracts from the Kaiser Permanente 2018 National Quality Conference


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