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From Schwartz to Reflections Rounds: why reflecting on patient care is important for staff wellbeing
28 April 2020

Reflections Rounds are Barking, Havering & Redbridge University Hospitals NHS Trust’s spin on Schwartz Rounds, the structured forums that many hospitals use to bring staff together to discuss the emotional and social aspects of working in healthcare. To further emulate the good practice that Schwartz had brought, the department rolled out Surgical Reflections Rounds, after an initial testing phase, with great success. Mr Saswata (Sas) Banerjee, endoscopy lead and co-lead for gastroenterology, sat down with us to discuss the value of Reflections Rounds and what they hope to achieve with the initiative.

Sas was part of the multi-disciplinary group who came up with Reflections Rounds. This involves two or three people presenting cases that have had an emotional impact on them, whether that’s a patient dying or a difficult decision they had to make about a patient’s care. It is an opportunity to share something in an environment where you will not be judged or interrupted, and what Sas calls ‘a group therapy’.

How did you promote this concept initially to your team to get the engagement?

'This idea of group therapy was a suggestion when I attended a HEE masterclass but the examples were relatively ad hoc. Around this time, the consultants, juniors, nurses, administrative staff and managers were particularly stressed and with the help of a few trainees we announced it by email, and held the first one instead of a regular weekly teaching session. The first one was very successful and that has helped this to be a sustainable idea.'

What has been the impact of the Reflections Rounds? Did you see better teamwork, improved moral and staff feeling safe to raise concerns?

‘The long term impact is all of the above and for a regular safe space to help develop resilience.’ 

For Sas, one of the benefits of Reflections Rounds is that nobody’s given a real guideline as to how to tell their story because every story is unique. The sessions are usually moderated by foundation doctors (F1s) to direct the flow of questions and discussions after the speaker presents their case. 

‘We saw the resilience of junior doctors, and consultants even, and the impact of what we were doing – discussing emotional stories had a positive impact.’

This has resulted in some powerful stories that generate a lot of emotion in the room – both from the presenters and audience. Sas himself presented a case about losing a patient with memory loss who suffered complications following surgery. Before the patient died, his family presented Sas with a painting he had made for him in his final weeks. ‘That was one of the most humbling things and at the same time one of the most thoughtful gifts I’ve ever had’. After discussing the painting at the Reflections Round, several colleagues encouraged Sas to hang the painting in his office to honour the patient – something he had not been able to bring himself to do before sharing the story. ‘[The painting] is part of the hospital now.’

Around 40–50 gastroenterology, endoscopy and surgical staff attend the sessions, from administrators to consultants to – on one occasion – the chief executive, who was touched by the effect of the gathering. People even come in on their days off to take part in the sessions, which is a testament to how valuable they find the support and dialogue that these Rounds provide. Sas wants his team to feel empowered and to be able to have a voice. ‘This has an impact on, ultimately, this magic word called “culture”.’

The department has presented the initiative at a number of surgical conferences including the London Surgical Symposium. The long-term goal is to introduce Reflections Rounds in the six other divisions in the trust and beyond. Sas hopes that it will become a ‘standard, routine [practice] that happens throughout med school’. By standardising it during training, incoming healthcare professionals will understand the value of having a safe space to share, reflect and discuss their personal experiences in the industry. 

What are 5 things that could help a service start implementing Reflections Rounds?

1. Find a safe space for an hour session.
2. Ensure invitation and engagement of multidisciplinary teams including management and admin.
3. Create golden rules for the session, these may include sitting in a circle with a chair, having 5 to 10 minutes per story with no interruptions and no questions about clinical care.
4. Ensure all communication devices are switched off and encourage conversation. 
5. Tea and coffee after is helpful but not essential. 


We would like to give special thanks to Mr Sas Banerjee for taking the time to sit with us and share ​his story. This blog post was written before the COVID-19 pandemic. We hope learning from this will help support staff who have been affected by these unprecedented times. 

Share your thoughts with us on Twitter. Will you be implementing Reflections Rounds in your service?

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