Table 4 Implementation of core-peripheral components in UK organisations
Core components | ||
Component | As implemented in practice in UK | Fidelity/adaptation |
1: Focus and purpose | Focus on social and emotional issues for staff maintained by skilled facilitation Implementers conceptualise Rounds primarily as a staff wellbeing intervention, which then links to improved patient experiences of care [2] | High fidelity to focus Some adaptation to purpose |
2: Generalised Rounds format | Formally structured, tight control over format Clear distinction between panellists and audience | High fidelity |
2a: Co-facilitation | Facilitators come from a range of backgrounds. Minority of organisations only have one facilitator | Usually high fidelity, some adaptation |
2b. Pre-prepared staff stories | The extent and nature of preparation varied between Rounds sites and facilitators-some phone only others face to face. Occasionally panellists given virtually no preparation. | Usually high fidelity |
2c. Audience discussion | Audience discussion time varied, but usually between 30 and 40 min | High fidelity |
2d. Participants | Rounds open to all staff; Medical professions attendance is encouraged, but not crucial. Majority of Rounds have at least one doctor present, others many doctors present. Clear distinction between panellists and audience. | High fidelity |
2e: Safe environment | Pre-Round emotional and psychological ‘safety checks’ during panel preparation; Confidentiality sign-in form and ground rules and facilitators support contributors to feel safe. | High fidelity |
2f: Rounds Leadership/organisational support | Rounds sites often have ‘Medical’ leads, though some sites are led by other disciplines, i.e. ‘Clinical’ leads Board/ senior managers presenting and/or attending Rounds All sites have multi-disciplinary planning groups, though participation and attendance vary | Usually high fidelity, some adaptation |
2g: Food | All Rounds have food provided. Some sites provide cold buffet, others provide hot dishes. | High fidelity |
3. Integrity | Educational aspects present but not explicitly emphasised (e.g. Role modelling/ discussions of excellent practice). Rounds not combined with other interventions. | High fidelity |
4: Regularity | All organisations run Rounds as ongoing events, rather than one off. Some sites have runone-off ‘demonstration Rounds’ to publicise them. | High fidelity |
Peripheral components | ||
Component | As implemented in practice in UK | |
1. Diversity | Rounds targeting single professions, specific wards or specialty based and only ran in part of an organisation. Usually adapted Rounds for specific staff groups are held in addition to Rounds which are organisation-wide. | |
2: Number of panellists | Usually Rounds have three or four panellists. One site always ran Rounds with a single ‘presenter’, but found they were unable to sustain Rounds within the organisation because of lack of willing ‘presenters’. | |
3: Type of Rounds | UK sites only have ‘theme’ or ‘case’ based Rounds. Not running Patient-presenter Rounds as mentors and trainers believe that having a patient present at Rounds alters the group dynamics and purpose. | |
4. Duration | ‘Pop up’ Rounds are small scale Rounds. They only last half an hour and are offered in addition to organisation-wide Rounds. They are designed to reach staff who cannot usually attend Rounds (e.g. ward-based staff). | |
5: Scale | Scaled down (e.g ‘Pop up’ Rounds). Scaled up (e.g. participants from other healthcare organisations). | |
6: Generalised Rounds format | Some experimenting with format to hold Rounds which use pre-recorded films to stimulate discussion, or invite panellists/ audience to attend via teleconferencing/ videoconferencing. | |
7. Frequency | Rounds are usually monthly, except for peak holiday periods (e.g. December and August). Some cancellations due to last minute panellist drop out, low audience numbers. A couple of examples of large healthcare organisations holding two or more Rounds a month, at different hospital sites, or rotating each month between sites. | |