REPORT DETAILS

A Randomised Controlled Trial of Schwartz Rounds

An evaluation of the impact of Schwartz Rounds - a collaborative discussion group for staff, focusing on the social and emotional aspects of work - in reducing psychological distress in staff in ten children’s social care departments, conducted by CASCADE, Cardiff University.

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Summary

Workplace wellbeing is a challenge in children’s social care, with high rates of sickness absence and turnover amongst social workers.

Schwartz Rounds – an intervention which provides a forum for staff of all levels to share their experiences, stories, and reflections on the challenges of their work – have been shown to be effective in healthcare and clinical settings, but never tested in children’s social care before.

WWCSC funded a randomised controlled trial in ten local authorities, working with social workers and other staff.

The study aimed to test whether these open fora have an effect on staff wellbeing and workplace stress. Though not statistically significant, the research found that those who were invited to Schwartz Rounds reported a slightly lower number of sickness-related absences (those in the intervention group recorded, on average, 4.56 sick days, compared to 4.63 in the control group), and had lower average GHQ-12 scores – a widely used measure of psychological distress – 13.5 for the control group, compared to 12.9 for the treatment group. The qualitative feedback from those who participated in Schwartz rounds was almost universally positive, with staff reporting benefits in relation to personal wellbeing, collegiate relationships and their direct work with children and families.

The report recommends that local authorities consider providing Schwartz Rounds as part of their efforts to support staff wellbeing.

Objectives

The objective of this evaluation was to understand if the use of Schwartz Rounds could affect the levels of psychological distress and sickness-related absence from work among children’s social care staff.

How we went about it

We used a randomised controlled trial (RCT) design. Staff members in the ten participating authorities were randomly assigned to an intervention group (invited to attend Schwartz Rounds) or a control group (asked not to attend Schwartz Rounds during the trial period). The aim was for each local authority (LA) to provide six Schwartz Rounds, although in practice some LAs provided only three, four or five.

We used an online survey to collect baseline data from both groups prior to the first Schwartz Round and to collect outcome data after the final Schwartz Round within the trial period. The General Health Questionnaire (GHQ-12) was the primary outcome measure. The GHQ-12 is a widely used and validated measure of psychological distress. In the survey at the end of the trial, we also asked staff to self-report the number of days they were off work due to ill-health in the previous six months.

After each Schwartz Round, staff were asked to complete a feedback form, and throughout the study we conducted key informant interviews, focus groups with staff, and observed at least one Schwartz Round in each authority. We also collected feedback from the Point of Care Foundation, who license and provide training for the intervention.

Key findings

The qualitative feedback from staff was almost universally positive, with staff reporting benefits in relation to personal wellbeing, collegiate relationships and their direct work with children and families.

At the point of the survey at the end  of the intervention, staff in the intervention group had lower average GHQ-12 scores, and a smaller proportion had elevated GHQ- 12 scores compared with staff in the control group. Staff in the intervention group reported a slightly lower number of sickness-related absences in the previous six months compared with the control group. None of these differences reached the level of statistical significance.

The intervention was relatively low-cost to deliver, with initial set-up costs ranging from £5,204.75 and £6,505.14, and running costs per Schwartz Round ranging from £288.24 to £2,711.60 (the majority of which was the indirect cost of staff time for those who attended).

Implications

It is feasible to implement Schwartz Rounds within children’s services. The vast majority of staff who attended found them to be a positive experience, reporting a mixture of benefits in relation to personal wellbeing, collegiate relationships, and their direct work with families. A small minority of staff did not find them helpful, and some of these found them to be upsetting and chose not to attend any more.

We found clear signs of promise that regular attendance at Schwartz Rounds in children’s services may be associated with decreased levels of psychological distress and fewer sickness-related absences from work, with some large effect sizes, although the differences between the intervention and control group were non-significant. Considering the findings holistically, we recommend that LAs consider providing Schwartz Rounds (or continuing to provide Schwartz Rounds) as part of their efforts to support staff wellbeing.