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After an Adverse Event, Staff Needs Support

Tami Swartz, March 28, 2013

"Let us not forget that some second victims react in a very positive way after being involved in an accident: They ask more questions, follow additional training, are more precise, … so not all second victims are at risk for additional failures. Therefore I think that ­emotional support is necessary immediately after the event," says Kris Vanhaecht, MD, RN, MSc, PhD, leader of Health Services Research Group, School of Public Health, KU Leuven, ­University of ­Leuven, Belgium. Vanhaecht coauthored the study "Supporting involved health care professionals (second ­victims) following an adverse health event: A literature review" ­published in the ­International Journal of Nursing Studies in July 2012. A total of 21 research articles and 10 non-research articles were cited in the literature review, which found that a hospital should have a plan in place for ­addressing the needs of second victims and should ­identify the organization as a whole as a third victim.

How a healthcare organization reacts to a second ­victim can be crucial for its future culture of safety.

One study in this literature review stated: "When healthcare institutions do not support their people, they will lose all the trust and respect and in the long term it will harm the culture of the organization."

"It is clear that after an adverse event [AE] there can be three types of victims. The first victim, the most important one, is the patient and his or her family. The second victim is the involved healthcare professional and team ­members. The third victim is the involved organization and the involved managers," says Vanhaecht, who taught quality in healthcare within the School of Medicine when an experience triggered his interest. During exams, students analyze and discuss a case study on an AE.

"One evening, two medical doctors each discussed an AE in which they were personally involved. Both of their patients died because of what we call a system failure, but in both cases they were the human element. One of the MDs coped in a positive way after the AE: He learned from it, he talked about it with his junior doctors and nurses, all despite the lack of support after the event."

The second MD had a more negative reaction after the event: He could not sleep for weeks, was afraid to talk about it, wanted to change jobs, was talking about a personal failure, and had very low self-esteem," says Vanhaecht. "He even started to cry during the exam and explained to me that it was the first time he talked about the event in such detail. He even apologized for his 'childish behavior.'

Vanhaecht was intrigued by the stories he heard and sought out more information. He contacted James ­Conway, MD, then senior vice president at the IHI who also authored the literature review. Conway put him in touch with Albert Wu, MD, MPH, a Johns Hopkins professor who introduced the term "second victim" in a British Medical Journal article back in 2000, and Sue Scott, a researcher on second victims at the University of Missouri, both coauthors of the review.

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