Research Article
Volume 3 Issue 5 - 2020
Surgical Reflection Rounds as an Organisational Innovation to Improve Staff Resilience
Heman M Joshi, Francesco Di Maggio*, Claire Macgregor, Niroo Rajendran, Dip Mukherjee and Saswata Banerjee
Department of Surgery, Queens Hospital, Romford, Barking, Havering and Redbridge Hospital Trust, United Kingdom
*Corresponding Author: Francesco Di Maggio, Department of Surgery, Queens Hospital, Romford, Barking, Havering and Redbridge Hospital Trust, United Kingdom.
Received: April 15, 2020; Published: May 27, 2020


Introduction: Owing to the growing demands, high levels of expectations and increasing stress experienced by many clinicians, alarming rates of burnout and depression threaten their wellbeing. Studies on physicians’ suicide collectively show moderate (men) to high (women) elevated suicide rate ratios. More than half of UK doctors report significant symptoms of burnout - a rate more than twice that among professionals in other fields.

There is an urgent need for more research examining the psychological well-being of healthcare professionals as it plays a fundamental role in recruitment and retention and has a direct impact on patient safety. We aim to assess the effectiveness of reflection rounds in improving resilience in healthcare professionals.

Methods: Between October 2017 and April 2018, a two-group non-randomized controlled trial design evaluated the effect of surgical reflection rounds (SRR) on a study vs control group of healthcare workers at a teaching hospital in London. 98 participants were interviewed using a Conor-Davidson Resilience Questionnaire (CD-RISC10). Data analysis was performed by descriptive statistics, independent-sample t test, one-way ANOVA, and regression analyses. Wilcoxon signed rank test was used to compare scores on the pre- and post SSR CD-RISC questionnaires. Results were considered to be significant at p < 0.05.

Results: 120 participants were included (response rate = 81.67%). There were 44 healthcare workers in the SRR cohort and they were matched with 44 control healthcare workers who did not participate. The majority (68%) were female. Most of them were junior doctors (64%). Respondents were mostly junior doctors equal or below 39 years of age (70%). The mean baseline resilience score was 75.9 (SD 6.0, range 40 - 110). In multivariate analysis, only marital status, age group, and seniority remained significantly associated with resilience level. The mean CDRISC score in the SRR group was 88.62 +/- 9.32 compared to 83.14 +/- 8.59 in the control group after 6 months. This result was statistically significant.

Conclusion: There is a need for effective evidence based strategies to improve resilience in clinical populations, thereby positively impacting on patient safety. Our study demonstrates surgical reflection rounds can be effective in building resilience amongst our staff.

Keywords: Resilience; Staff Well-Being; Professional Burnout


  1. Mealer M., et al. “A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses”. Intensive Care Medicine 9 (2012): 1445-1451.
  2. Dyer C and Cohen D. “How should doctors use e-portfolios in the wake of the Bawa-Garba case?” British Medical Journal 360 (2018): k572.
  3. Shanafelt TD., et al. “Addressing Physician Burnout: The Way Forward”. The Journal of the American Medical Association 9 (2017): 901-902.
  4. Grossman DC. “Reducing the stigma: faculty speak out about suicide rates among medical students and physicians”. AAMC news (2016).
  5. Dyrbye LN., et al. “Healthy Exercise Habits Are Associated with Lower Risk of Burnout and Higher Quality of Life Among U.S. Medical Students”. Academic Medicine 7 (2017): 1006-1011.
  6. Kim HS and Yeom HA. “The association between spiritual well-being and burnout in intensive care unit nurses: A descriptive study”. Journal of Intensive and Critical Care Nursing (2018): S0964-3397.
  7. Point of Care Foundation. We are working to radically improve the way people are cared for and to support the staff who deliver care.
  8. Goodrich J. “Supporting hospital staff to provide compassionate care: Do Schwartz Center Rounds work in English hospitals?” Journal of the Royal Society of Medicine 3 (2012): 117-122.
  9. National Institute for Health Research. A longitudinal national evaluation of Schwartz Centre Rounds: an intervention to enhance compassion in relationships between staff and patients through providing support for staff and promoting their wellbeing (2014).
  10. Goodrich J Schwartz. Center Rounds: evaluation of the UK pilots (2016).
  11. Connor KM and Davidson JR. “Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)”. Depress Anxiety2 (2003): 76-82.
  12. Campbell-Sills L and Stein MB. “Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience”. Journal of Traumatic Stress 6 (2007): 1019-1028.
  13. West MA and Dawson JF. Employee engagement and NHS performance (2012).
  14. Robertson R., et al. Public satisfaction with the NHS and social care in 2017: results and trends from the British Social Attitudes survey (2018).
  15. Matthews-King A. “More than 100 000 NHS posts unfilled, reveal “grim” official figures”. Independent (2018).
  16. Robert G., et al. “Exploring the adoption of Schwartz Center Rounds as an organisational innovation to improve staff well-being in England, 2009-2015”. BMJ Open (2017).
  17. Smith F., et al. “Adverse effects on health and wellbeing of working as a doctor: views of the UK medical graduates of 1974 and 1977 surveyed in 2014”. Journal of the Royal Society of Medicine 5 (2017): 198-207.
  18. Shernhammer ES and Colditz GA. “Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis)”. The American Journal of Psychiatry 12 (2004): 2295-2302.
  19. Guille C., et al. “Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns”. JAMA Psychiatry12 (2015): 1192-1198.
  20. Clarke R and McKee M. “Suicides among junior doctors in the NHS”. British Medical Journal 357 (2017): J2527.
  21. American Foundation for Suicide Prevention.
  22. STEPS forward – presenting physicians distress and suicide.
Citation: Francesco Di Maggio., et al. “Surgical Reflection Rounds as an Organisational Innovation to Improve Staff Resilience”. EC Clinical and Medical Case Reports 3.6 (2020): 166-174.

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