What’s New in the
Patient Safety World
April 2018
Joint Commission
and the Second Victim
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:
- Instill a just culture for learning from system defects and communicating lessons learned.
- Engage all team members in the debriefing process and sharing of the lessons learned from the event analysis.
- Provide guidance on how staff can support each other during an adverse event (i.e., how to offer immediate peer-to-peer emotional support or buddy programs).
- If the EAP is the sole source of support for second victims, consider creating supplemental programs after evaluating the EAP’s structure and performance.
It goes on to describe components your organization should include if you have, or decide to create, a second victim program:
- A strong patient safety culture, which is an essential foundation for implementation of a clinician support program.
- Obtain buy-in from organization leadership and the board.
- Engage executive champions.
- Develop an educational campaign to introduce the second victim concept, reduce stigma and biases, increase awareness and the utilization of services. Staff should know exactly what to expect if they are involved in an adverse event and how to access support.
- Develop policies and procedures, including guidance for direct first responders.
- Develop the program using evidence-based guidance and ensure that the program is applied fairly toward all staff.
- Identify the current confidentiality protections designed for the support program. (Leaders may want to seek legal counsel about options for preserving confidentiality since state laws vary.)
- Create additional tiers of service for those who do not recover with peer support or who endure litigation.
- Identify professional resources for external intervention to ensure that the unique needs of each clinician are met.
- Survey health care workers to determine benchmarks of program effectiveness (one resource is the Medically Induced Trauma Support Services (MITSS) Toolkit noted below). Repeat the surveys regularly to track progress.
- Measure utilization of the program, but keep in mind that low rates of use may reflect program deficiencies or barriers to access rather than lack of need.
- Measure effectiveness of the program and services; revise the program, if needed.
Our August 2017 What's New in the Patient Safety World column “ROI for a Second Victim Program” 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”:
- December 17, 2013 “The
Second Victim”
- July 14, 2015 “NPSF’s
RCA2 Guidelines”
- June 2016 “Disclosure
and Apology: The CANDOR Toolkit”
- August 9, 2016 “More
on the Second Victim”
- August 2017 “ROI
for a Second Victim Program”
References:
TJC (The Joint Commission). Quick Safety Issue 39: Supporting second victims. January 22, 2018
Johns Hopkins’ RISE (Resilience In Stressful Events) program
https://www.johnshopkinssolutions.com/solution/rise-peer-support-for-caregivers-in-distress/
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)
http://www.mitsstools.org/index.html
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