A Massachusetts hospital has found that interprofessional educational rounds can be an effective way to discuss adverse events and other topics that might be difficult for some clinicians to address openly in the normal course of their work.

The rounds provide a structured, safe way for clinicians to address issues that can be emotional and stressful, says Christine M. Rachwal, MSN, RN, CCRN, clinical nurse specialist with Boston Children’s Hospital. Those difficult issues are plentiful in a children’s hospital, she notes.

The monthly, hour-long rounds are part of the Program to Enhance Relational and Communication Skills (PERCS), which also includes workshops. Participation is voluntary and offered to interprofessional clinicians from four critical care units, the cardiac catheterization unit, and intermediate care unit, Rachwal says. Topics are developed collaboratively.

“There were a lot of issues happening on the units that people wanted to talk about, and we wanted to make sure we allowed that opportunity in a guided, facilitated educational approach,” Rachwal explains. “It’s very different than a support group. This is much more of an educational format.”

The rounds are effective because they are conducted in a learning format and with specific parameters, says David M. Browning, MSW, LICSW, co-founder of the hospital’s Institute for Professionalism and Ethical Practice.

“The rules of engagement, in terms of how the time is protected and the safety provided for people to speak, is central to the success of the rounds because in a hierarchical healthcare environment people are not always open and honest in talking about topics they really care about,” Browning says. “Creating an environment in which people can do that makes this special. It’s learning in a different way than people are sometimes accustomed to.”

The process starts at the beginning of each month with a planning meeting that involves facilitators, support staff, a registered nurse, and representatives from ethics, psychiatry, and other areas. There also are representatives from the hospital’s parent advisory group.

Six units participate — four critical care, one acute care, and one intermediate care. The units rotate twice a year to bring their concerns to the table, highlighting what they would like to be addressed.

“We consider the suggestions and look for what people are going to get the most benefit from, produce an objective for the session later in the month, develop a title, and think about what experts from the institution we’re going to invite to contribute to the discussion,” Rachwal says. “One topic that had a lot of interest was pediatric consent, with some parents not wanting their child to know what was happening. People were concerned about the legal aspects, so we invited legal to contribute.”

A flyer is distributed to all the critical care units and then the rounds are held a few weeks later. Rachwal and Browning are usually the key facilitators, accompanied by the people asked to contribute to that month’s topic. An administrative coordinator keeps the program on time, takes notes, and helps participants with continuing education credits.

Some sessions are conducted as group discussions, while others are organized with a whiteboard listing the key topics and staff concerns, along with potential solutions.

“People can see it in black and white and then discuss their own experiences. We always want them to leave feeling like they were presented with potential solutions and had their voice heard,” Rachwal says. “The parents who participate are so important because we want to make sure we get all aspects and all viewpoints of a situation.”

Participants are assured of confidentiality. The sessions last about an hour. At the end, the facilitators go around the room asking each participant to describe what they are going to take away from the meeting.

“We have found on some occasions that their answers to that question reveal we need to dive into this a little deeper with another round,” Rachwal says.

The hospital originally held the rounds in a central conference space but found that attendance lagged because clinicians found it difficult to be away from their units. Now the rounds are held on the units, with as many as 30 participants.

Physician attendance also has been a challenge, Rachwal says. They are pulled in many directions, but attendance is improving with the use of “champion” physicians who believe in the idea and promote the program in the same way champion nurses promote it to their peers, she says.

The hospital described the program in a study available online at: https://bit.ly/2TEnifm.


• David M. Browning, MSW, LICSW, Institute for Professionalism and Ethical Practice. Boston Children’s Hospital. Phone: (617) 355-5021.

• Christine M. Rachwal, MSN, RN, CCRN, Clinical Nurse Specialist, Boston Children’s Hospital. Phone: (617) 355-6000.