John Nance’s award-winning book Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care describes health care as a complex system with potential for catastrophic consequences. Health care is a human enterprise—and as a result, it is imperfect. We should recognize that it’s not a matter of if, but when, because humans will always make mistakes regardless of our training. In fact, most preventable harm done to patients is caused by unintended human error and systems failures.
According to Donald Berwick, MD, outgoing administrator of CMS and former president and CEO of the Institute for Healthcare Improvement, few health care organizations use a systematic way to take care of their clinicians who find themselves involved in adverse events that harm patients. Instinctively as clinicians, when something bad happens, our hearts naturally go out to the injured patient and family. They are the first and most important victims. But clinicians are hurt too. And if we are really healers, then we collectively have a job of healing them too.
Physicians and other members of the health care team who struggle with the emotional aftermath of a medical error have been described in literature as the “second victims.” Researcher Susan Scott, RN, MSN, at University of Missouri Health Care, and her team developed this commonly used definition:
Second victims are health care providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.
When an error occurs, clinicians report that they isolate themselves and withdraw in shame. Some will scrupulously review the moments of the event countless times, thinking, “If only I would’ve …” They will condemn themselves as being not good enough, and second-guess other clinical decisions. They will struggle to concentrate and suffer a host of physical problems. Unfortunately, the risk of making a subsequent error also grows when a health care provider experiences the stress and symptoms of a second victim. Therefore, offering a warm hand of support to an affected provider isn’t just the ethical thing to do, it’s the safest thing to do.
In 2007, a University of Missouri Health Care system survey reported that 1 in 7 caregivers (14 percent) had experienced a patient-safety event within the past year that had caused personal problems such as anxiety, depression, or concerns about the ability to perform one’s job. By 2010, a follow-up survey showed the number had climbed to 1 of every 3 caregivers (30 percent).*
Promoting a culture of caregiver support
Today too few clinicians are supported adequately by their organizations following an adverse event. However, several promising support models are being developed and implemented by Scott and by others. These programs raise awareness through all-staff education and provide support from peers and specially trained rapid-response team members.
One example is a program at University of Missouri Health Care, forYOU, which provides 24/7, free, confidential support to clinicians reacting to a stressful event or outcome. Trained peers from a range of disciplines support caregivers one-on-one, so the caregiver can explore normal reactions and feelings after adverse events. Additionally, forYOU educates coworkers and their families about the second victim phenomenon and prepares managers with tools to support second victims.
Physicians Insurance is committed to improving the quality of medical care and patient safety. With the growing body of knowledge showing that the health and wellness of providers is correlated with patient safety through the prevention of medical errors, Physicians Insurance is a recognized leader in providing evidence-based assistance to strengthen resilience in our member-providers. Our expanded Provider Support Program promotes provider wellness by offering innovative services to our members, including:
- Litigation and Provider Support Program: Dr. Ron Hofeldt provides confidential coaching after serious adverse events or when lawsuits are reported.
- Provider Support/Wellness Committee Consultations: We offer ongoing consultation to provider support/wellness committees to help members establish robust provider support programs and a culture of provider wellness and safety. Our consultations include:
- Assisting facilities to integrate provider support/wellness committees as part of a confidential Coordinated Quality Improvement Program (CQIP) quality committee or hospital QI program
- Educating committee members about their roles and responsibilities
- Targeting consultation on provider-specific support issues
- Offering external resources, as necessary
- Offering tailored provider education on a variety of topics, including caring for the caregiver, provider wellness, promoting patient safety through situational monitoring and provider wellness program, and just culture in health care
- Adverse Event Response Team (AVERT) Program Training: Our 2½-hour program is a groundbreaking experiential education initiative that helps to ease the traumatic effects of a poor medical outcome on the patient and health care team. Our AVERT Program Training enables health care providers to address the needs of patients, families, caregivers, and facilities following an adverse event. The training can be tailored to specialty groups.
- Balint Group Formation: A Balint Group is a group of providers who meet regularly and present clinical cases in order to better understand the physician-patient relationship. These programs are adopted as part of a facility’s QI program to protect confidentiality of the discussions. CME is offered to participants.
- Leadership and Provider Retreats: We offer tailored presentations on a variety of provider support/wellness topics and work with facility leaders to ensure relevance to the audience.
As a member of a health care team, you can begin to promote this culture shift by advocating for implementation of robust provider support programs in your organization. Please feel free to contact us directly for additional resources, literature, and support.
As John Nance wrote, human mistakes are inevitable. But when they occur, we as healers can help alleviate our coworkers’ suffering, perhaps as well as our own.
Patricia McCotter can be reached at firstname.lastname@example.org, (206) 343-6511, or 1-800-962-1399.
* Susan D. Scott, RN, MSN, “The second victim phenomenon: A harsh reality of health care professions,” Morbidity and Mortality Rounds on the Web, May 2011, <http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=102>