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The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds® from the United States to the United Kingdom.
Department of Mental Health Nursing, Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Adult Nursing Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.ORCID iD: 0000-0001-8781-6675
School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.
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2019 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 19, no 1, article id 457Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Schwartz Center Rounds® (henceforce Rounds) were developed in the United States (US) in 1995 to provide a regular, structured time and safe place for staff to meet to share the emotional, psychological and social challenges of working in healthcare. Rounds were adopted in the United Kingdom (UK) in 2009 and have been subsequently implemented in over 180 healthcare organisations. Using Rounds as a case study, we aim to inform current debates around maintaining fidelity when an intervention developed in one country is transferred and implemented in another.

METHODS: Interpretive design using nine qualitative interviews (UK = 3, US = 6) and four focus groups (UK: Focus group 1 (4 participants), Focus group 2 (5 participants; US: focus group 1 (5 participants) focus group 2 (2 participants) with participants involved in Rounds design and implementation, for example, programme architects, senior leaders, mentors and trainers. We also conducted non-participant observations of Rounds (UK = 42: USA = 2) and training days (UK = 2). Data were analysed using thematic analysis.

RESULTS: We identified four core and seven sub-core Rounds components, based upon the US design, and seven peripheral components, based on our US and UK fieldwork. We found high core component fidelity and examples of UK adaptations. We identified six strategies used to maintain high fidelity during Rounds transfer and implementation from the US to UK settings: i) having a legal contract between the two national bodies overseeing implementation, ii) requiring adopting UK healthcare organisations to sign a contract with the national body, iii) piloting the intervention in the UK context, iv) emphasising the credibility of the intervention, v) promoting and evaluating Rounds, and vi) providing implementation support and infrastructure.

CONCLUSIONS: This study identifies how fidelity to the core components of a particular intervention was maintained during transfer from one country to another by identifying six strategies which participants argued had enhanced fidelity during transfer of Rounds to a different country, with contractual agreements and legitimacy of intervention sources key. Potential disadvantages include limitations to further innovation and adaptation.

Place, publisher, year, edition, pages
BioMed Central, 2019. Vol. 19, no 1, article id 457
Keywords [en]
Compassionate care, Fidelity, Healthcare workforce, Implementation, Innovation, Schwartz center rounds®, Staff wellbeing
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:hj:diva-47057DOI: 10.1186/s12913-019-4311-yISI: 000475532900009PubMedID: 31286958Scopus ID: 2-s2.0-85068913418Local ID: GOA HHJ 2019;HHJIMPROVEISOAI: oai:DiVA.org:hj-47057DiVA, id: diva2:1377205
Available from: 2019-12-11 Created: 2019-12-11 Last updated: 2022-09-15Bibliographically approved

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