In 1999, playwright Margaret Edson won the Pulitzer Prize for Drama for her play Wit. This story became a compelling movie starring Emma Thompson as a college English professor whose work focused on “religion and death as literary motifs” in 17th-century British poetry.
The professor had advanced ovarian cancer. At first, she approached her ordeal as a social experiment. She agreed to participate as a patient in grand rounds and to accept eight courses of experimental chemotherapy.
She engaged in banter with her caregivers as intellectual equals. As time passed, and her treatments did not work and her body continued to fail, she realized that the healthcare professionals were turning away from her. This was not because they didn’t want to help but because they had no more care to give. She articulated a key call to action: “Now is the time for caring.”
As we know, life can imitate art, and thus, it did. In 1994, around the time the play debuted, Kenneth B. Schwartz, a 40-year-old healthcare attorney, was diagnosed with advanced lung cancer. Before he succumbed, he realized that caregivers make the unbearable bearable. His observations gained attention in July 1995 when The Boston Globe magazine told his story, in his own words, of receiving compassionate care. This was the birth of a movement focused on supporting and fostering resilience among caregivers and healthcare providers, and bringing compassion to every healthcare experience.
Losing the “Why” of Our Profession
One of the shortcomings in U.S. healthcare is the mantra that doctors are always right. This is a common expectation of modern society, and one that physicians often impose upon themselves. A physician executive from Intermountain Healthcare in Utah recently opined on this issue, putting forth the query, “Does training suck out our compassion?” The grueling years of medical school, residency and often, fellowship take in bright-eyed, eager and compassionate college graduates, and 12 years later (on average), discharge into the caregiving environment very tired human beings who have sacrificed their 20s and early 30s, and who quite often have lost the “why” of their initial entry into the profession. Quint Studer, the noted process improvement guru, describes the “why” of healthcare as connecting to purpose, doing meaningful work and making a difference in people’s lives. Many healthcare trainees enter the field with this solid “why” and then lose their way. We must adapt differently to a model of caring and learning, which must not be mutually exclusive. We cannot let the high-tech nature of much of what we do allow us to forget for a moment that someone’s mother, father, sibling or child is at the center of every encounter.
“We must adapt differently to a model of caring and learning, which must not be mutually exclusive.”
At the end of the day, physicians and other care providers are humans caring for other humans. Once we sit back, take a deep breath and reflect on that, we realize that the work we are expected to do in this highly complex environment is nearly designed to force us to lose our connection with our emotional being. Understanding this, Mr. Schwartz graciously endowed a center, the Schwartz Center for Compassionate Healthcare in Boston, Massachusetts. The foundational innovation from this center is Schwartz Rounds®, which is quite different from the clinical-based grand rounds we are familiar with in the physician community.
Schwartz Rounds® sessions are scheduled during the work day. Participation is voluntary and open to every employee in the hospital. The forum supports open, honest discussion of the emotional issues faced in caregiving. Hundreds of caregiving environments throughout the nation and the world now offer Schwartz Rounds®. Each one-hour session has a focused topic, a panel discussion, food (very important!) and an opportunity for the participants to voice their experiences and reflect on their own feelings.
Schwartz Rounds® at RWJBarnabas Health
Recognizing the impact of disconnection, burnout and stress on our workforce engagement, on our patient outcomes and on our team members’ health and well-being, RWJBarnabas Health implemented Schwartz Rounds® at all 11 of our adult acute care hospitals and two additional inpatient sites (Barnabas Health Behavioral Health and Children’s Specialized Hospital) in 2019. Three of our hospitals in New Jersey—Saint Barnabas Medical Center in Livingston (600-bed inpatient), RWJ University Hospital – Somerset in Somerville (350-bed inpatient) and Monmouth Medical Center in Long Branch (350-bed inpatient)—had been holding Schwartz Rounds® for several years and had found them to be extremely beneficial. They became the model for the other 10 sites and, in conjunction with the Schwartz Foundation, the system’s caregivers embarked on a journey toward providing compassionate, empathetic outlets for and reconnection to our their own emotional needs.
“The candor, tears and nods in agreement with the difficulty of their chosen profession normalize the feelings and provide a sense of community.”
We have held Rounds on topics such as “Our Feelings Following a Workplace Violence Event,” “The Emotional Impact of Organ Procurement Patient/Family Situations,” “Gone Too Soon—Pediatric Fatalities,” “Employee Illness Coworker Support” and “The Patient You’ll Never Forget.” On average, 100 physicians, nurses, medical residents, environmental service aides, social workers and others gather to hear each other’s stories and share the emotions behind their difficult work. The candor, tears and nods in agreement with the difficulty of their chosen profession normalize the feelings and provide a sense of community. These emotions and our team members’ compassion are not newly found because we started Rounds—these team members, who we ask so much of, have been living and working with this burden all along. However, there was no outlet. Through Schwartz Rounds®, our caregivers receive peer support and share their vulnerability, which ultimately has a positive impact on their teamwork, and therefore, on employee and patient experience.
Through Schwartz Rounds® as one element of our wellness work, we at RWJBarnabas Health want to support our team members in feeling connected to the humanity and meaning in their work. We know that, in turn, they will continue to provide empathy, compassion and kindness to their patients. In November 2019, I had an extraordinary learning experience while attending the Press Ganey National Client Conference in Orlando. Dr. Merit Cudkowicz, Chief of Neurology at Massachusetts General Hospital and Director of the Sean M. Healy and AMG Center for ALS, delivered a compelling proposition: “We are not defined by our role but by the kindness we show each other.” 1 She works with patients with amyotrophic lateral sclerosis (ALS) who often have difficult diagnoses and prognoses. Her toolkit contains instruments far more important than pharmaceuticals, machines and surgical Olympics. She is a living enactment of what Maya Angelou once wrote: “People will forget what you said. People will forget what you did. But people will never forget how you made them feel.”
Making the Unbearable Bearable
Eighteen years ago, I received a cancer diagnosis. At the time, I had a wonderful wife and three children who were in high school, college and medical school. I was the CEO of a successful major medical center. One might say everything in my life could not have been better, and that was true. But it takes only a moment to derail the train.
“This simple act of kindness allayed my high anxiety and broke my spiraling emotional downfall until I received positive results.“
While waiting to go through the computed tomography (CT) scanner to rule out metastasis, I literally thought I would lose my mind, and my heart was beating in a way it never had before. It was my darkest moment, but I felt, in my role, I needed to somehow try to make it my finest hour. Despite that intellectualization, my emotions were winning. As I lay on the CT table, Karen Mount, the Director of Radiology with whom I had worked for several years, approached me and took both of my hands in hers. She looked me in the eye and said, “Dr. B, you’re going to be fine.” This simple act of kindness allayed my high anxiety and broke my spiraling emotional downfall until I received positive results. Karen made the unbearable bearable, and I will never forget how she made me feel.
To keep caregivers like Karen connected to humanity and emotionally open to providing big and small moments of healing for their patients, we must normalize the complexity, burden and stress that caregiving is. Our Schwartz Rounds® sessions are one step toward bringing humanity back to healthcare.