This document describes the Schwartz Center Rounds model, which provides facilitated discussions for healthcare providers to discuss difficult emotional and social issues in caring for patients. The goal is to promote compassionate, patient-centered care. Evaluations show Rounds increase providers' insight, improve teamwork, and make them feel more supported. They also report providing more compassionate care and considering patients' personal lives more after attending Rounds. Some hospitals have changed practices or policies based on Rounds discussions.

1. Professional Model of Care:
Patient and Family-Centered Care
Enhanced by
Schwartz Center Rounds®
C504
2010 ANCC National Magnet Conference®
October 13, 2010 2:30 p.m. - 3:30 p.m.
Bridget Mudge RN, MS, CNS-BC
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Marjorie Stanzler, Senior Director of Programs
The Kenneth B. Schwartz Center, Boston, MA

2. Objectives
 State the value of facilitated conversations to
express caregivers' thoughts and feelings
about difficult situations
 Apply an innovative model for improving
compassionate patient and family-centered
care

3. Dartmouth-Hitchcock Medical Center

4. Ken Schwartz
 40-year-old father
and husband from
Boston, MA
 Diagnosed with lung
cancer, non-smoker
 Died in September,
1995

5.  Published in Boston Globe Magazine July, 1995
 Ken believed that his care represented the best
that the system could offer: caregivers that are
 Compassionate
 Engaged
 Willing and able to spend the necessary time
 All patients should get the same quality of care
 Financial pressures may take the humanity and
empathy out of health care
A Patient’s Story

6. “I’ve been touched by the smallest gestures – a
squeeze of the hand, a gentle touch, a
reassuring word. In some ways these quiet
acts of humanity have felt more healing than
the high-dose radiation and chemotherapy
that hold the hope of a cure.”
-Kenneth B. Schwartz
A Patient’s Story

7.  Established in 1996 by family, friends, and
caregivers to promote Ken’s vision
 Provide a strong and active voice for promoting
and preserving a healthcare system that values
compassion and effective communication for
every patient
The Kenneth B. Schwartz Center

8. Relationships, “whole person” knowledge of patients and
effective communication are associated with:
 Improved clinical and functional status
 Enhanced patient and physician satisfaction
 Increased adherence to recommended treatments
 Patient trust
 Reduced malpractice claims
Studies by Safran, Stewart, Novack, Beckman, and others
Why are relationships and
communication important?

9.  There are few opportunities for healthcare
providers to enhance relationships, to learn
the advanced communication skills needed in
our complex healthcare environments, and to
provide support for each other.
The gap between need and
opportunity

10.  To provide a forum and “level playing field” where
caregivers from diverse disciplines discuss difficult
emotional and social issues that arise in caring for
patients
 To explore the human and emotional side of clinical
medicine – but with the focus on the patient-caregiver
relationship rather than solely the patient
Goals of the Schwartz Center
Rounds

11.  Started at Mass General Hospital in Boston in 1997 as a pilot
 Currently in nearly 200 sites in 31 states
 Mostly hospitals, including 33 Magnet hospitals
 Some nursing homes and outpatient practices
 Schwartz Center responding to calls from all over the US
 Targeting hospitals as part of strategic plan in specific geographic
areas where we have “clusters” of Rounds hospitals
 MA, ME, NH, VT, RI, CT, NY, NJ, PA, FL, MI, IL, DC area
 National Cancer Institute (NCI) sites or (NCI) Community Cancer
Center Program sites
 Also targeting prestigious academic medical centers across the
country
 Piloting Rounds in 2 hospitals in the U.K. – 1st
international site
Expansion

12.  Buy-in from senior administration, senior
physician and nursing leadership
 Physician leader
 Facilitator
 Administrative support for logistics
 Evaluations and quality control
Key Features

13. Planning Committee at CHaD
Pano Rodis, PhD; George Little, MD; Bridget Mudge, RN; Toni LaMonica, MSW;
Patrick McCoy, Chaplain; Kyleigh Mercier, RN (not shown)
Schwartz Center Rounds

14.  Multidisciplinary caregivers ( typically 8-10)
 Publicize Rounds
 Schedule and assign presentations for the
year
 Adjust presentation schedule with timely
topics
 Program evaluation
 Budget planning
Planning Committee

15.  Based on specific patient case
 Panel of multidisciplinary caregivers describe
their experience with patient (10-15 minutes)
 Remainder of hour devoted to discussion
among attendees
 Share experiences, thoughts and feelings
 Confidential, safe environment
Rounds Format

16.  Healthcare professionals: physicians, nurses,
social workers, psychologists, physical
therapists, care managers
 Hospital administrators, clergy
 CHaD average attendance 40 (20-60 range)
 National average 50 ( 20-100 + range)
Rounds Participants

17.  Nurses
 Residents
 Security
 Child Abuse Team
 Social Workers
 Physicians
 Palliative Care
 Chaplain
 Nursing Ethics
 Child Life
Groups Assigned for Topic
Selection

18.  Respect and Dignity
 Information Sharing
 Participation
 Collaboration
Source: Institute for Family-Centered Care 2010
Principles of Patient and Family-
Centered Care

19.  Providing compassionate care when a family
complains
 Welcome to CHaD: When the unit doors are
locked
 My patient’s mom looks sick. Is it my job to ask
about it?
 Complex child with simple parents
 Family centered care in child abuse
Sample Topics

20.  Biting, swearing, screaming, and hitting: How
do you provide compassionate care?
 Separating twins: When a pre-adoptive family
decides against adoption of a disabled twin
 Staying overnight: How to provide safe but
family centered care
 Hurricane Katrina: Our reaction and lessons
learned
Sample Topics

21. “Provides a forum for all the disciplines to discuss
some complex and often difficult cases. It’s great to
get everyone’s different perspectives based on their
professional discipline. It is a supportive place
especially when dealing with morally and ethically
complex topics.”
“I especially appreciate the safe and confidential place
to self disclose our feelings.”
Testimonials from Dartmouth-
Hitchcock Medical Center

22.  Getting nursing staff to the meetings
 Confidentiality
 Avoiding problem solving
 Allowing discussion of emotions
Challenges

23.  Building a Magnet® culture
 Creating a culture change
 Team building
 Improve interdisciplinary communication
 Increased insight into non-clinical aspects of
care
 Decreased stress
Benefits

24. “Voices of Caregivers”
Schwartz Center Rounds Video
“Voices of Caregivers”

25. Hired outside firm to conduct comprehensive
quantitative and qualitative evaluation
After attending the Schwartz Center Rounds, do
caregivers report:
 Increased insight into the non-clinical aspects of
patient care?
 Improved teamwork?
 Increased support?
 Providing more compassionate care?
Evaluation Questions

26. Evaluation Methods
 Retrospective Study
 Web-based survey of 256 providers at 6
experienced sites (Rounds ongoing > 3 years)
 44 interviews with providers, Rounds leaders and
facilitators, hospital administrators
 Prospective pre-post study
 Web-based surveys of 222 providers at 10
hospitals newly implementing Rounds (pre) and
after > 7 Rounds (post)
 Supplementary interviews

27. Slightly, somewhat or strongly agree:
 87% new ideas/strategies for patient situations
 84% more compassion for patients and families
 86% more likely to consider effects of illness on
personal life of patient
 84% more energized about work with patients
Caregivers report impact on
patient care:

28. Some or a great deal of improvement in
teamwork:
 93% appreciation for the roles/contributions
of colleagues from other disciplines
 88% sense of belonging to a caregiving team
 76% less alone in work with patients
Caregivers report impact on
teamwork:

29.  Caregivers in retrospective study reported
feeling less stressed, better able to cope with
non-clinical demands and less overwhelmed
by emotions
 For both new and experienced sites:
 The more Rounds attended, the greater the
impact
 Attending with co-workers associated with greater
improvement in teamwork
Other Key Findings:

30. Approximately 50% of respondents observed changes in
practices or policies within the department or in the
hospital at large, as a result of Rounds discussions
 Unique and profound contribution/changing culture
 fills a hole in the clinical community
 a philosophy that [Rounds set] the standard for care
 Greater use of palliative care/new palliative care services
 Change in nursing care in ICU
Study subject of article published in Academic Medicine in June, 2010
Perceived institutional outcomes

31. "Rounds are a place where people…are willing to
share…their vulnerability, to question themselves. Rounds
are an opportunity for dialogue that doesn’t happen
anywhere else in the hospital.”
“There is more heart in what we do with patients…the
connections are deeper, we are less afraid of difficult
topics. Since we know there is support for us in the
institution, we’re willing to take more risks.”
In caregivers’ own words…

32. Bridget Mudge, RN, MS, CNS-BC
Dartmouth-Hitchcock Medical Center, Lebanon, NH
(603) 650-7029 Bridget.O.Mudge@Hitchcock.org
Marjorie Stanzler, Senior Director of Programs
The Kenneth B. Schwartz Center, Boston, MA
(617) 726-0914 mstanzler@partners.org
Professional Model of Care:
Patient and Family-Centered Care Enhanced by
Schwartz Center Rounds