Exploring factors that contribute to the successful implementation of Schwartz Rounds in higher education institutions

TL;DR

This study explores how to successfully implement Schwartz Rounds in universities to support healthcare students' wellbeing and compassionate care.

Contribution

The study identifies key factors for implementing Schwartz Rounds in higher education, including leadership, student involvement, and local adaptation.

Findings

Five out of six HEIs successfully implemented Schwartz Rounds during the study.

Support from external organizations and motivated teams were key drivers of success.

Student involvement and engagement activities helped embed Rounds into university culture.

Abstract

With rising concerns about workforce shortages and early-career attrition, there is increasing focus on the difficulties healthcare students encounter during training. Schwartz Rounds are a structured group intervention where healthcare staff share stories about the emotional, ethical and social impact of their work. As students spend substantial time in clinical settings, Higher Education Institutions (HEIs) are adopting Rounds to support wellbeing and foster compassionate care. While evidence suggests that Rounds are well received by students, less is known about how to ensure successful implementation in this setting.

Longitudinal, mixed-methods (qualitative dominant) case studies were conducted in six HEIs in the South of England between April 2022-December 2024. Data collection across 20 months included semi-structured interviews with those running and attending Rounds (n=19), non-participant observations of Rounds activities (including steering group meetings, storyteller preparation meetings, and Rounds) (n=38), post-Round feedback surveys (n=481), and bespoke forms with key information about each Round (e.g., attendance) (n=32). Quantitative data were analysed descriptively, and qualitative data thematically. Data were summarized in matrices to examine patterns within and across sites using the Framework Method and mapped to the Consolidated Framework of Implementation Research.

Five of the six HEIs implemented Rounds during the study period. Key drivers included support (financial, resources) and credibility from external organisations. Within the HEIs, four interlinked features of the inner-setting and intervention aided successful implementation: 1) Motivation of Schwartz team, with facilitators championing Rounds, senior clinical leads lending authority, active steering groups, and tailored administrative support); 2) Engagement activities to inform students what Rounds are and when/where they took place; 3) Involving students in delivery to foster ownership; 4) Engaging wider staff to increase awareness and endorsement. These activities increased familiarity with Rounds over time and produced early signs of them becoming embedded in university culture.

This study offers new insights into the implementation of Schwartz Rounds in HEIs, highlighting key enablers and barriers. Success was shaped by local adaptation, leadership engagement, team support and student involvement. Findings can aid adoption and implementation of Schwartz Rounds in HEIs and other organisations aiming to support student practice and wellbeing.

The online version contains supplementary material available at 10.1186/s12909-026-08793-9.

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