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 distressing1. The feelings of guilt, shame, incompetence, anxiety that are reported to be experienced by the healthcare staff involved in these situations are heightened when the individual perceives it was possibly something they did or did not do which caused the patient safety incident. Of the 1,463 doctors we surveyed in the UK2, 76% believed the experience of a patient safety incident affected them personally or professionally. 74% reported stress, 68% anxiety, 60% sleep disturbance and 63% lower professional confidence. Moreover, 81% became anxious that they might doing something again in the future which could lead to another patient safety incident.
It is not only doctors who experience physiological distress after involvement in an incident. In another study3we found nurses showed higher levels of distress following a patient safety incident than doctors. For many, the emotional impact of being involved in an incident is short-lived, but for other individuals the effects are long-lasting. In our sample, 8% of doctors reported symptoms associated with post-traumatic stress disorder. This impact on the healthcare employees is the reason the term ‘second victim’ was coined. The emotional impact of being involved when something goes wrong are many, but there are other impacts too which make it so very important that employers, managers and colleagues don’t disregard, ignore, or even punish further the individuals involved.
There is evidence that distress and further loss of confidence can often be exacerbated by the patient safety incident investigation process – and this can lead individuals to burnout, a state of hyper-vigilance and/or the practice of defensive medicine. Some ‘second victims’ may even choose to leave the profession, especially in the absence of timely and tailored support from those around them. From a moral standpoint, supporting people in distress is essential and this includes supporting healthcare employees involved in patient safety incidents. From a healthcare organisational perspective, there is a patient safety, a staff health and well-being, and financial imperative to do so.