Why support second victims?

There is now a huge amount of evidence from different countries and across different professional groups that being involved in a patient safety incident, particularly one where the patient is seriously harmed or dies can be very distressing (Sirriyeh, Lawton and Gardner, 2010). The feelings of guilt, shame, incompetence, anxiety that are reported to be experienced by staff in these situations are heightened when the individual feels that it was their error or mistake that caused the adverse event. Of the 1,463 doctors we surveyed in the UK (Harrison, Lawton and Stewart, 2014), 76% believed that the experience of a patient safety incident had affected them personally or professionally, 74% reported stress, 68% anxiety, 60% sleep disturbance and 63% lower professional confidence. Moreover, 81% became anxious about the potential for future errors. It is not only doctors who suffer. In fact, in another study (Harrison et al., 2015) we found that nurses showed higher levels of distress following an adverse event than doctors.

For many people the emotional impact of the error is short-lived, but for some the effects are long-lasting. In our sample, 8% of doctors reported symptoms associated with post-traumatic stress disorder. This is why the term ‘second victim’ was coined. The emotional impacts of making an error are many, but there are other impacts too that make it so important that we don’t ignore, or even punish further, those that have been involved in an adverse event. There is evidence that a loss of confidence and distress that is often exacerbated by the incident investigation process can lead to burnout, hyper-vigilance and the practice of defensive medicine. Without support, second victims may even choose to leave the profession. From a moral standpoint, supporting people in distress is essential. There is also a safety and financial imperative to do so.

Patient Safety Incident Response Framework

To support the NHS to further improve patient safety, NHS England and NHS Improvement are introducing a new Patient Safety Incident Response Framework (PSIRF). The PSIRF describes a new approach to incident management, one which facilitates inquisitive examination of a wider range of patient safety incidents “in the spirit of reflection and learning” rather than as part of a “framework of accountability”.

Informed by feedback and drawing on good practice from healthcare and other sectors, it supports a systematic, compassionate and proficient response to patient safety incidents; anchored in the principles of openness, fair accountability, learning and continuous improvement. The plan for the introductory version of the PSIRF is for implementation by nationally appointed early adopters in 2021.

The PSIRF  outlines how providers should respond to patient safety incidents and how and when a patient safety investigation should be conducted. It clearly sets out how the needs of those affected by patient safety incidents – patients, families, carers and staff – are met.

Organisations must establish procedures to identify all staff who may have been affected by a patient safety incident and to provide access to the support they need.

Appendix three of the PSIRF lists the national sources of support for healthcare professionals affected by a patient safety incident, and signposts to this Second Victim Support website.

Second victim support systems

A 2021 Healthcare Safety Investigation Branch national learning report further highlights the need for support systems for staff. Figure 2 in the report describes some of the approaches which may be offered before and/or after involvement in a patient safety incident.

Many NHS organisations already recognise the need to improve the support they offer their staff after they have been involved in a patient safety incident and are looking at ways to achieve this. These two case studies are examples of support systems for staff in NHS organisations in England.

Case study 1 – Leeds Incident Support Team (Leeds Teaching Hospitals NHS Trust) – peer support service for second victims

Who?

The risk management office at Leeds Teaching Hospitals NHS Trust (LTHT)

What?

Support for second victims provided by staff members who have themselves been involved in an incident and have made a commitment to be available to talk to other staff in a similar situation.

LIST members are identified by badges with the LIST logo, and a central list of these staff members is held by the risk management office.  They have been trained to provide advice and support relating to the investigation process

Individuals who have been involved in an incident are able to approach any member of staff with a LIST logo for support, or contact the risk management office to be put in touch with someone.

The LIST function operates in addition to the Trust’s wider staff support offer including support from line managers, the Employee Assistance Programme (access to counselling), Clinical Psychology and the Occupational Health service.  If LIST members have concerns about a colleague’s health and well-being they have information to “signpost” the member of staff to these other services for help.

Further information:

Scott, S.D., Hirschinger, L.E., Cox, K.R., McCoig, M., Hahn-Cover, K., Epperly, K.M., Phillips, E.C. and Hall, L.W., 2010. Caring for our own: deploying a systemwide second victim rapid response team. Communication of Critical Test Results.

Case study 2 – Critical Incident Stress De-Briefing Team (Bradford District NHS Foundation Trust)

Who?

Twelve members of staff have completed training to receive accrediation as stress debriefers.

What?

Bradford District Care NHS Foundation Trust (BDCT) is committed to providing a timely and supportive response in the aftermath of serious incidents. The World Health Organization et al (2011) developed guidance on psychological first aid and the structured debriefing of those affected by stress situations and symptoms in the workplace. Critical Incident Stress Debriefing (CISD) is a recommended approach for supporting teams to have space to process their experience of the impact of serious incidents (Harrison & Wu (2017) and particularly focusses on how people are coping and can support one another to cope with that impact.

Full case study here.