PERCS Rounds: A Clinical Ethicist’s Reflections from the “One-Room Schoolhouse”

by Kerri Kennedy

How does one learn the art of navigating difficult clinical encounters with compassion and skill?  Thankfully, IPEP has developed an innovative approach to teaching this art, sometimes referred to as the “one-room schoolhouse” which creates a space for diverse practitioners to learn from and alongside each other.  The Program to Enhance Relational Communication Skills (PERCS) Rounds at Boston Children’s Hospital is one example of this educational approach. The monthly, hour-long forum is conveniently held on patient care units and draws interdisciplinary professionals together to discuss and explore challenges they face in everyday practice. In my role as a clinical ethicist at Boston Children’s Hospital, I regularly participate in the NICU-based PERCS Rounds. I would like to share a few reflections about what I find so valuable about them:

We’re all in this together.  PERCS Rounds is a safe forum for staff to take a brief pause from their work to join with colleagues and discuss the myriad challenges they face in day to day practice. Because the topics are selected by unit staff members themselves, attendees typically find them highly relevant and useful to their practice. The PERCS Rounds discussions are wonderfully engaging and create a sense of shared experience which fosters a sort of camaraderie (“I’m not the only one who finds this challenging…”). And these discussions are far from vent sessions. Those who participate are rewarded with new ideas and strategies for addressing the difficult conversations and clinical challenges they are facing. It is especially gratifying to see junior staff members learning from more senior ones…and vice versa!

“None of us is as smart as all of us.” This famous quote by Kenneth H. Blanchard, an IPEP favorite, nicely captures the spirit of the “one-room schoolhouse.” During PERCS Rounds planning, great care is taken to consider who to invite to a given Rounds that can bring expertise best matched to the topic at hand. This gives participants access to the knowledge and talents of a wide range of hospital professionals, from interpreters to child life specialists, even experts in meditation. In the same vein, I often find that PERCS Rounds is a natural forum for providing ethics education, and in a manner that is responsive to the real time needs and questions that participants have.

These people inspire. People sometimes ask how I cope with the sadder aspects of my work. My reply is simply, “I find the people so inspiring.” The patients, the parents, the clinicians – they are profoundly resilient. PERCS Rounds creates a space where this resilience can be seen, shared, and further cultivated. Recently, members of IPEP’s family faculty have begun regularly participating in PERCS Rounds. This inclusion of the patient/parent voice adds a crucial layer of richness to discussions and helps to keep the focus on the patient, who is always at the center of our care. Time and again, I am moved by my colleagues’ dedication to providing the best care for patients and families, and I have often reflected that this work truly draws out the best of the human spirit. I think that’s pretty inspiring.

 

Kerri Kennedy MA, RN is a clinical ethicist at Boston Children’s Hospital.  There, she coordinates and facilitates ethics consultations, conducts unit-based ethics rounds, and assists with the development and implementation of ethics-related institutional policies.  In addition, Kerri is an active member of the Boston Children’s Ethics Advisory Committee, participates in the Harvard Clinical Ethics Consortium, and serves on the Harvard Task Force on Ethical Issues in Emergency Preparedness.

 

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