Safeguarding the second victim of patient safety incidents

In the last post we discussed ‘the predicament of the second victim of patient safety incidents‘. Here we will review the many recommendations that have been advanced to mitigate the emotional, physical and professional consequences of patient safety incidents on the affected physicians. At the core of the recommendations is the need to support the affected doctor throughout the course of their ordeal. SD Scott and colleagues identified six stages of recovery of the second victim in their paper titled The natural history of recovery for the healthcare provider “second victim” after adverse patient events, and the doctor needs support through these:

    • Chaos and accident response
    • Intrusive reflections
    • Restoration of personal integrity
    • Enduring the inquisition
    • Obtaining emotional first aid
    • Moving on: by dropping out, surviving, or thriving
Memorial Anguish. Image MD on Flickr. https://www.flickr.com/photos/imagemd/8181921657

Perhaps the most important support for second victims is the one that comes from their colleagues. In this regard Albert Wu, in his paper titled Medical error: the second victim, made the following  recommendations to physicians on how to support each other when adverse patient incidents occur:

    • Asking how the colleague is coping
    • Enquiring about the emotional impact of the mistake
    • Acknowledging the emotional impact of the mistake
    • Not minimising the mistake’s importance
    • Disclosing their own past mistakes to minimise the second victim’s ‘sense of isolation

Andrew White and colleagues, in their paper titled Supporting health care workers after medical error: considerations for health care leaders, also encouraged doctors to establish physician support groups ‘to discuss and acknowledge emotionally challenging patient communication dilemmas‘.

Melancholy Woman. Lluís Ribes Mateu on Flickr. https://www.flickr.com/photos/lluisribes/49384151342

Most of the recommendations made to reduce the burden of second victims are however targeted at health institutions. For example, White and colleagues advised organisations to address the four needs of physicians after an error, and these are:

    • ‘The opportunity to talk to someone about the mistake’
    • Reaffirmation of their competence’
    • Validation of their decision-making process’
    • Reassurance of their self-worth’

Matthew Grissinger also reviewed the important needs of second victims which hospitals should support in his paper titled Too many abandon the “second victims” of medical errors. The needs he listed are:

    • To have their errors treated with respect
    • To participate in the process of learning from the error
    • To be held accountable in a fair and just culture
    • To be supported by their organisational leaders
    • To be provided with ‘a sense of community, rather than isolation’
Melancholy. Lluís Ribes Mateu on Flickr. https://www.flickr.com/photos/lluisribes/24620410242

Charles Denham, in his paper titled TRUST: The 5 rights of the second victim, also explored the role of healthcare institutions in supporting the second victim. He emphasised that the behaviour of the hospital’s leadership has a direct effect on the second victim, and when this leadership is poorly exercised, the hospital itself may end up as the third victim of the patient safety incident. Denham recommended specific approaches to supporting the second victim which are covered by the acronym TRUST. He noted that the first of these, treatment that is just, implies that the second victim should not be presumed to be negligent ‘in the face of systems failures that predispose caregivers to human error‘. He therefore urged the organisation to adopt a non-punitive approach in dealing with the patient safety incident.

Melancholy by Odilon Redon. Rawpixel Ltd on Flickr. https://www.flickr.com/photos/vintage_illustration/33649205588

Another key recommendation Denham made to hospitals was for them to treat the second victim with respect, and to dispense with the usual ‘name-blame-shame cycle‘ that he said denies the practitioner ‘even the most basic elements of respect and common decency‘ after an error. He rather urged hospitals to treat second victims with understanding, compassion, and transparency; to extend supportive care to them; and to offer them the opportunity to contribute through the disclosure process. In a similar line, White and colleagues also urged healthcare institutions to minimise the effect of patient safety incident investigations on physicians by ensuring that the process is not ‘repeated, poorly timed, disorganized, confusing, or unsympathetic‘ – a situation that worsens the impact on the physicians who are forced to ‘relive and examine their mistakes in front of others’.

My latest acquisition. Tony Alter on Flickr. https://www.flickr.com/photos/78428166@N00/5219131877

We have now concluded our exploration of the management of patient safety incidents. We will next review the management of human factors.

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