Abstract
Background
Schwartz Rounds (or “Rounds”), a facilitated group reflection forum for healthcare staff, have shown benefits in healthcare provider settings. They are now being implemented for pre-registration healthcare students in higher education institutions (HEIs). This realist inquiry investigates how Rounds have been adapted to this new context.
Aims
To conduct a two-phase realist research project, to develop, test, and refine an evidence-informed programme theory for Rounds run for pre-registration healthcare students, within their HEIs. The final programme theory aims to answer, in this contextual setting, what works, for whom, in what circumstances, and why?
Methods
- A realist synthesis of evidence on Rounds run within HEIs for pre-registration healthcare students was conducted, producing an initial programme theory (IPT) for Rounds in this context. The IPT was augmented by realist interviews with four key participants.
- A realist evaluation of Rounds was undertaken at three case-study sites, further developing, testing, and refining the IPT towards a final evidence-informed programme theory of Rounds in this HEI setting. Data included observations (Steering Group meetings, storyteller preparation, Rounds) and realist interviews with students, staff, storytellers, and site mentors.
Results
Context-mechanism-outcome configurations (CMOs), linking outcomes observed for Rounds to salient modifying contexts, via generative causal mechanisms, were used as an analytical heuristic, producing a final evidence-informed programme theory. Six complexly interlinked CMO groups were found: -
- Emotional safety
- Resonance
- Reflective insight and practice
- Psychological wellbeing
- Environment
- The feedback, planning, and preparation cycle
Conclusion
This is the first in-depth study of Rounds in this organisational context in the UK and globally, advantaged by taking a complexity science approach, utilising realist methods appropriately matched to this complex social intervention. A final evidence-informed programme theory has been produced, revealing considerations for organisations when adapting Rounds to local needs.