'Schwartz rounds' at the hospital: a program to help the helpers
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.
Health caregivers have a regular chance to share their thoughts and feelings about their work lives through a program called the Schwartz rounds, which Upstate has offered for several years. I'm checking in today with Brigid Dunn. She's a chaplain from Upstate who's the coordinator of the Schwartz rounds. Welcome to "The Informed Patient," Chaplain Dunn.
Chaplain Brigid Dunn: Thank you, Amber. It's a joy to be here with you.
Host Amber Smith: The Schwartz Center for Compassionate Healthcare, I know, is a national nonprofit that was founded in 1995. Can you tell us why it was created?
Chaplain Brigid Dunn: It was created by a gentleman named Kenneth Schwartz, who was a lawyer in Boston, and he came to a terrible diagnosis of, terminal cancer when he was 40 years old. It was a terrible irony because he was a healthy person. He was a marathon runner and, there he is with cancer.
During his 10-month ordeal of being treated, he was motivated to help the health caregivers who helped him. He said even a gentle touch made a big difference. So he wanted to leave a foundation, a legacy, where he would care for the caregivers who made the unbearable bearable for him.
Host Amber Smith: I know that Upstate is a member. Do you know how many other hospitals and health organizations are members of the Schwartz Center?
Chaplain Brigid Dunn: Throughout the world, there are, approximately 500, in the U.S. And Canada in the UK and Ireland and in Australia and New Zealand. Actually there are three in Syracuse alone who are members, too. It's an amazing program.
Host Amber Smith: Let's talk about what is the Schwartz rounds? How does that work? It's called Schwartz rounds because it comes from the Center for Compassionate Healthcare, right?
Chaplain Brigid Dunn: Yes. We have them at Upstate six times per year, in October, November, December, and then we take a break, and it's February, March, April, or sometimes, May, depending.
It's been interesting over COVID because we used to meet live and in person, and we'd offer lunch. And, since COVID, we've been on Zoom, so it's been more convenient for some people. And it's been less personal for most of us who are used to the way that it was done beforehand.
It's an hour. Anyone who attends gets a continuing education credit (known as a CME). And we take a lot of our ideas from the evaluations that are submitted after each rounds.
Host Amber Smith: So who are the health care workers that typically participate? I'm assuming, doctors, nurses -- what other health care team members are there?
Chaplain Brigid Dunn: It's anyone. We have people from environmental services (the cleaning and maintenance department). We have people from nutritional services. We have chaplains. We have people who are in the C-suite (chief executive officers), so it's anyone who works at Upstate.
Host Amber Smith: So any of the hospital people, including administrators, anyone who's involved in taking care or making sure that the patient's stay goes as it should.
Chaplain Brigid Dunn: That's right.
Host Amber Smith: Is there an overriding goal? I mean, people are sharing stories with colleagues, but what is the end goal?
Chaplain Brigid Dunn: The goal is to help us see that we're not alone. That imperfection is part of the human experiment, that we have the opportunity to tell stories that other people will identify with. So usually when we have somebody, Who's a panelist. They tell a story or, all of the panelists will participate in talking about a particular case of a patient and they tell of their experience.
One example is that recently we had one about, child behavior and, even, self-destructive behavior among children and the, aggression that was experienced by the psychiatrist, by the people who had to come in and clean up the room, by whomever. It was a very stressful situation for anyone who was on the floor.
They told of that experience and that it's easy to identify a patient who's been particularly challenging or a family member who's been upset, understandably, because their loved one is sick, but whose behavior wasn't really helping the situation.
So they can say that in complete confidentiality. Everything that's on that Zoom meeting or that's in that room in the Cancer Center is kept confidential. It's never taped, so they can be assured of that. We're big gatekeepers on who comes into the Zoom meeting, so it has to be somebody who is an employee, no matter what department.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Brigid Dunn. She's a chaplain at Upstate and coordinator of the Schwartz rounds.
Now the Schwartz rounds are not for patients, I realize. It's for employees of the hospital, but do you think there's a benefit for patients knowing that this sort of thing exists?
Chaplain Brigid Dunn: I think there's a benefit in them knowing, yes, that Schwartz rounds is one prong of opportunities that are available to health care personnel, doctors, nurses, whomever, so that they know that the doctors are actually taking care of themselves, too. There's a terrible idea that it's weak to talk about what's wrong. And actually, like I said, it's part of the human experiment to make mistakes. It's going to happen. And we have to be able to discuss that somewhere safe. So I think that patients might not understand what Schwartz rounds is or why or when or where, but I think probably they know that their doctor is taking care of him- or herself, and that's probably reassuring, in some way.
Host Amber Smith: Now, as the coordinator, are you the one who chooses the topic or the theme for that particular Schwartz rounds?
Chaplain Brigid Dunn: No, rarely. I get a lot of suggestions from my advisory committee, comprised of doctors, nurses, case managers, the director of environmental services. They see what's going on and say, "We really have to do this. We have to talk about this. This will help us, help my people on my floor. We need to do this." So we get suggestions that way. And at the evaluations at the end of each Schwartz rounds, we ask please to suggest a topic. And then I go after people who would be good panelists for that.
Host Amber Smith: So you get a panelist lined up for a particular topic, or panelists, you may have more than one --
Chaplain Brigid Dunn: Yes.
Host Amber Smith: -- and then the people who come to the particular gathering, do they have to participate, or do you get some who come just to listen?
Chaplain Brigid Dunn: Many who come just to listen. And that's perfectly fine, but the panelists will speak. We tell them that they really only have to speak for five to seven minutes. Ideally, we have three or four panelists who tell their story for that length of time. And then the moderator will ask those who are gathered if they would like to comment or share, and again, if you're here, you have to remember not to name names when you go outside. And so everybody feels safe.
Host Amber Smith: Can you give some examples of some of the topics over the years that have been popular? Because I know this has been in place for several years now.
Chaplain Brigid Dunn: Yes, we are heading into our 10th year here.
Some of the topics that have been really popular: There was one actually done by my predecessor called " More Than 13 Reasons Why," and it was addressing adolescent suicide. And fortunately it did draw, but unfortunately it's a problem that had to be addressed.
But that's another thing: that we go there with whatever topic is necessary. So, one of the recent ones was about what's falling between the cracks during COVID? The opioid crisis continues, and how is Upstate addressing that? How are we as a culture addressing that?
Host Amber Smith: I imagine that during COVID we heard so much about how much stress health care workers were under. I mean, we were all under, but imagine, tenfold for someone working on the front lines. So I know you had to move to the Zoom format, but do you think people stayed connected through the Schwartz rounds during COVID?
Chaplain Brigid Dunn: I think we lost a few, and we gained a few that way. Because the CME is still out there. And sometimes people will tune in just to hear a doctor or nurse or colleague that they know who's presenting. So that's a way of getting new people to come. I think it, on average, in person, was usually around 25, 30 people who would come, and it was pretty much the same on Zoom. I would love it to get bigger. I would love that.
Host Amber Smith: You said CME, that's continuing medical education, and nurses, doctors, other technicians, they all have obligations to stay current in their field. So this fulfills some of that?
Chaplain Brigid Dunn: Correct. Thank you. Yes.
Host Amber Smith: Is there any evidence that a program like the Schwartz rounds improves health care for the patient?
Chaplain Brigid Dunn: For the patient, I think it filters down to like what I was saying before, that if there's wellness emphasized in the staff, then that will necessarily produce better results because the staff is healthier, and then they can attend to their patients better. We know that burnout happens because people feel shame and blame themselves because they can't keep up those incredible hours that are expected of them.
And if you're being treated by somebody who's a very tired doctor, then more mistakes will be made. So the urgency that we see for staff to care for themselves, I'm sure does filter down.
I read in JAMA, which is the journal of the American Medical Association, that there's a price tag attached to burnout of physicians in costs of physicians leaving, having to be replaced, the training, getting them on board, lost hours with patients. It's $4.6 billion per year. It's a terrible cost. But the other cost is people feeling burnout, feeling like they cannot continue in a career, in a profession, that they've trained for years to do.
Host Amber Smith: So, a counter to that to try to help reduce burnout might be, well, it sounds like health care workers talking about issues that are sometimes really hard to talk about.
Chaplain Brigid Dunn: Right.
Host Amber Smith: What do you see for the future of Schwartz rounds at Upstate?
Chaplain Brigid Dunn: I hope that everybody will know about Schwartz rounds soon and know that they are welcome to participate if they're an employee and that it will be just part of the fabric, just like they know that there's the cafeteria, they know that there's Schwartz rounds to be able to talk about things.
And feel welcomed and not feel anything except, really, pride in their work because it's a huge deal to take care of patients day in, day out. And during COVID we saw -- I usually take a title from the Beatles, and it was called "Eight Days a Week" -- about how there was this ongoing cycle of I'm leaving work, I'm back to work, I'm leaving work -- days just melted into each other.
So I want Schwartz rounds to be part of the overall wellness plan that is underway at Upstate.
Host Amber Smith: Well, Chaplain Dunn, thank you for taking time to tell us about it.
Chaplain Brigid Dunn: Thank you so much, Amber, what an honor. Thank you.
Host Amber Smith: My guest has been Brigid Dunn. She's a chaplain and coordinator of the Schwartz rounds at Upstate. "The Informed Patient" is a podcast covering health science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/informed.
This is your host, Amber Smith, thanking you for listening.