Joint Commission urges support for healthcare workers, who are also 'victims' after an adverse event

Doctor pausing with a frown on his face
The Joint Commission advises hospitals and healthcare systems to support the "second victims" of an adverse event: the healthcare workers involved in the case. (Getty/Wavebreakmedia)

When a patient suffers an adverse event, it can also take a toll on the healthcare professionals directly involved, which is why healthcare organizations need to offer them support, says The Joint Commission.

The healthcare accreditor issued a new Quick Safety advisory yesterday to provide healthcare organizations with research, recommendations and resources on how to address and support so-called second victims: the healthcare professionals who can also experience emotional and physical effects when medical care goes wrong.

It’s estimated that nearly half of all healthcare providers will experience second-victim syndrome at least once in their careers, according to a Joint Commission announcement. Healthcare professionals can experience difficulty sleeping, reduced job satisfaction, guilt and anxiety, and other emotional and physical problems after an adverse incident. And for some, recurrent memories of the adverse event can contribute to burnout, depression, post-traumatic stress disorder and suicidal ideation that can affect medical judgment, the accreditor said.

One study last year, published by BMJ Open, found that the more stress an ER physician experiences, the more likely he or she is to make a mistake.

Sweeping adverse events under the rug and not allowing staff to talk about what happened only adds to the second-victim problem.

“If not treated, a second victim experience can bring emotional and physical harm to our healthcare providers who work so hard to treat and care for patients,” Ana Pujols McKee, M.D., the Joint Commission’s executive vice president and chief medical officer, said in the announcement. “Unfortunately, many second victims find themselves in need of support and care that many healthcare organizations are not prepared to provide. This emphasizes the importance of establishing second victim programs which play a critical role in strengthening safety culture, as well as reducing stigma and biases.”

Healthcare organizations need to recognize the potential problem and help healthcare professionals involved in adverse events, the commission said. The accreditor suggests hospitals and healthcare organizations:

  • Create a culture in which the organization learns from system defects and communicates lessons learned
  • Include all team members in the debriefing process after an adverse event and share lessons learned from the analysis
  • Provide guidance to staff on how they can support each other during an adverse event, such as offering peer-to-peer support or buddy programs
  • Develop programs that go beyond an employee assistance program, with supplemental programs to support second victims.

The advisory includes suggestions on the components organizations should include in setting up a second-victim program.

Providing staff support was one of six actions organizations can take to reduce burnout—which is estimated to impact 54% of doctors—and increase physician engagement, Stephen J. Swenson, M.D., told participants at the American College of Healthcare Executives Congress last year. He described a nurse who made a mistake that led to the death of an eight-month-old child and who later committed suicide.

With 435 physician suicides in 2016, healthcare must take care of second victims, he said, and just as healthcare organizations support patients, families and friends, they need to support their staff members.

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