Caring for staff is the key to a compassionate health service

Jocelyn Cornwell is Chief Executive of the Point of Care Foundation. She spoke to us about the Foundation’s work to improve patient and staff experience, and her belief that in order to treat patients with compassion and respect you have to treat staff the same way.

Why is improving how health services support staff so important?

The ‘care’ part of health care can be rather fragile and precarious. We know that when people feel overworked, stressed, disempowered and unappreciated it affects their ability to empathise with others and therefore patient care suffers as a result.

The converse is also true. When staff feel supported by colleagues, appreciated and empowered this spills over into greater empathy and compassion in the care they provide. The evidence for this has been growing over the last few years and is now very strong.

And when I say staff I mean all staff who have contact with patients, it’s not just about nurses. We need to support the whole multidisciplinary team, and beyond them to the support staff: receptionists, porters and cleaners, HR, finance. We’re talking about changing organisational culture so everyone needs to be involved.

What is the Point of Care Foundation doing to improve staff and patient experience?

The Point of Care Foundation launched in April last year. We’re building on work we started at The King’s Fund, which looked at how to improve patients’ experience of care and the support the NHS provides to staff.

Our premise is that a radical transformation is needed in our health service if we’re going to consistently deliver high quality and personalised care. We’re doing three things to try and make this happen: promoting and spreading methods that work, sharing the evidence on both patient and staff experience; and nurturing new thinking and looking for new things to test.  

At the moment our main work is implementing Schwartz Rounds and teaching organisations how to involve patients in quality improvement through our ‘Patients as partners in co-design' programme. This year we are also working with the Clinical Human Factors Group and have just announced the winners of a joint award for compassionate care.

Tell us more about Schwartz Rounds

They are a very simple organisational intervention, developed by the Schwartz Center for Compassionate Healthcare in Boston as a way of strengthening relationships between care givers and patients.

The Rounds are a monthly hour-long meeting that’s open to any employees who want to come along, where people can talk about the emotional impact of their work with patients. It’s really an organised process for creating a safe, confidential space in which staff can reflect.

We negotiated a license to introduce Schwartz Rounds to the UK and initially ran some pilots at the Royal Free and in Cheltenham, which were really successful. We now provide training to facilitators and support nearly 100 organisations to use Schwartz Rounds.

Why do they work?

We know from evaluations that the Rounds have a positive effect for the people that attend.

Hearing other people tell a story that resonates with you is very powerful and empowering, especially when that’s being shared between staff at all levels, from the medical director to a porter. By allowing time for reflection and open discussion they help place patients back at the centre of care and build better relationships between colleagues. People who attend them believe they cause a shift in team and organisational cultures.

In research terms proving the direct impact on patient experience is much more difficult, but in about two years’ time we’ll know a bit more. The National Institute for Health Research is funding a major academic review of the implementation of Schwartz Rounds in this country, led by Professor Jill Maben at King's College, London.

How can organisations know whether they are providing compassionate care and whether interventions like Schwartz Rounds are helping?

When you talk to people who run services, they’re very rarely surprised about where poor care is happening in the organisation, they tend to know already. However, directly measuring compassionate care is hard. There are compassionate care scales but there’s lots of debate about whether they’re any good.

It’s useful and important to think about the information already in the system that tells you about patients’ experience of care. There’s a whole fund of information available to NHS organisations to think about whether the care is good enough from the patient’s perspective, including most importantly talking to patients and families themselves. Then there’s looking at what people are complaining about, levels of staff engagement, and making sure that senior people are out and about observing care.

Is the government doing enough to get health services to focus on ensuring dignity and compassion in care, or do target culture and budget cuts get in the way?

It’s important not to set one aspect of quality up against another. Targets for access matter to patients a great deal. What we all want is care that’s accessible, but that’s also safe, clinically good, and where patients are treated well.

The effect of Mid-Staffordshire was immense, not just on organisations but on the wider system. And rightly so. Personally though I feel the government response has been very much weighted towards regulation. I would like to have seen more focus on empowering frontline staff to act on their own motivations to improve care and less of an emphasis on rules.