System change case study: Schwartz Rounds
Youth Futures Foundation has gathered this case study to help applicants to our Connected Futures Fund understand the kinds of things that might be involved in collective local efforts to change the ways that systems work. We recognise that the fund is not like ordinary project funding, and we hope you will find some of these case studies helpful prompts as you think through your application.
You do not have to copy or draw on this example at all. It is only an example, and it won’t all be relevant to you and your context – feel free to take what you need, and ignore the rest.
We will not give preference to applications that look like this example. We want to see your ideas for changing how things work.
What is it?
Shwartz Rounds are a structured process for clinical and non-clinical staff working in hospitals and other healthcare settings to discuss the emotional aspects of their work. A round involves a panel of clinical and non-clinical staff with different levels of seniority sharing experiences, followed by a facilitated open discussion.
The purpose is not to address specific clinical questions or solve problems, but to allow people to share and reflect on the emotional challenges and rewards of their work.
How does it work?
Rounds can help people feel more supported and less stressed in their jobs. Staff who take part feel less isolated, and increase their insight and appreciation for each other’s roles. This can help reduce hierarchies within services, especially clinical and non-clinical staff, and focus everyone’s attention on the relational and emotional aspects of care.
They are based on the idea that compassion makes all the difference to the patient experience, but that in order to provide compassionate care, staff need to feel supported and cared for themselves. Hospitals typically introduce Schwartz Rounds in response to unmet needs for staff support and/or high levels of stress.
What makes this an example of systems change?
Rather than explicitly setting out to change how care is delivered or organised, Schwartz Rounds are a kind of “under the radar” approach to systems change. Over time, the trust and sense of safety developed during the rounds “ripples” out into improved wellbeing and resilience, and greater compassion and empathy for others (both patients and staff), leading to changes in patient care and improved teamworking.
This kind of cultural change is not fast or easy. In a highly task- and outcome-focused environment such as the NHS, the open-ended, reflective nature of Schwartz Rounds is countercultural, and this can lead to resistance.
Elements of systems change:
- Doing something simple and practical to demonstrate that new approaches are possible
- Creating spaces to practise new ways of thinking, listening and relating
- Asking new questions to encourage new ways of thinking and working (from “what did you do” to “how did you feel”)
- Developing better relationships across hierarchical / disciplinary boundaries