The Joint Commission recently published a Quick Safety Issue on supporting second victims (TJC 2018). Our multiple columns on “the second victim” (see list at the end of today’s column) discuss the evolution of the approach to helping second victims. Back in the early 1990’s as we began dealing with investigations on serious events we recognized that those healthcare workers involved in serious events, either directly or indirectly, often had difficulty coping in the aftermath of such events. So we added a specific item to our Serious Incident Checklist for paying attention to any second victims.
The Joint Commission document notes that it is estimated that nearly half of health care providers could experience the impact as a second victim at least once in their career and that a 2014 survey of 1,755 physicians outside the U.S. found most physicians had been involved in a serious safety event and most admitted to experiencing second victim effects.
TJC notes most hospitals make the same mistake we made in the early days of patient safety - we often simply made available to second victims professional assistance (employee assistance programs or psychological counselling). Over the years, helping the “second victim” has evolved considerably and such referral for professional help is not a good first line strategy and may even be counterproductive. Support from peers is extremely important if such programs are to be successful.
TJC has the following recommendations:
It goes on to describe components your organization should include if you have, or decide to create, a second victim program:
Our August 2017 What's New in the Patient Safety World column “” focused on Johns Hopkins’ RISE (Resilience In Stressful Events) program and showed how the efforts made were likely very cost effective (Moran 2017). In our August 9, 2016 Patient Safety Tip of the Week “More on the Second Victim” and several other columns we also highlighted the work of Susan Scott and colleagues at the University of Missouri and their MITSS (Medically Induced Trauma Support Services) program.
Second victim programs are essential to any organization that has a good culture of safety. We hope you’ll go to our previous columns on such programs to see the details of what is involved in such programs.
Some of our prior columns on “the second victim”:
TJC (The Joint Commission). Quick Safety Issue 39: Supporting second victims. January 22, 2018
Johns Hopkins’ RISE (Resilience In Stressful Events) program
Moran D, Wu AW, Connors C, et al. Cost-Benefit Analysis of a Support Program for Nursing Staff. Journal of Patient Safety 2017; Post Author Corrections: April 27, 2017
MITSS (Medically Induced Trauma Support Services)