Risk Tips to Support “Second Victims”

PMP’s article Patient Safety Incidents: Supporting “Second Victims” discusses the phenomenon of the “second victim” and the impact it may have on clinicians. Patients are considered the “first victims” and healthcare organisations and clinicians have a duty to provide them with truthful information, appropriate follow-up care and emotional support. In addition to the harm suffered by the primary victim, evidence also suggests that an adverse event can have a significant personal and professional impact on a clinician. Clinicians may experience feelings of blame, anger, shame, failure, depression, inadequacy and distress. Following such an event, the key to a successful recovery is to ensure healthcare team members obtain appropriate support.

Strategies to support “second victims”

By acknowledging and proactively addressing the patient safety incident-stress-error cycle, clinicians can work towards effectively managing the situation. You may find the following helpful when dealing with the stress associated with an adverse patient outcome.

1. Be open and honest with the patient/family

When things go wrong, healthcare providers have an ethical responsibility to disclose unanticipated patient outcomes. It is essential to investigate, explain and apologise to the patient. For further guidance on your ethical obligations, please refer to GMC guidance, “Openness and honesty when things go wrong: The professional duty of candour”. Whilst clinicians may feel uncomfortable and anxious discussing adverse outcomes with patients and/or families, when done properly, disclosure can reduce the negative impact of adverse outcomes and support a culture of transparency and safety. Clinicians should inform their insurance provider of such incidents, subject to the terms and conditions of their policy.

2. Participate in peer review meetings

An adverse patient outcome, whilst unfortunate, can present an ideal learning opportunity to analyse your personal performance and the system in which you practice, to help identify contributory factors.

To maximise learning during the review, it is important to consider the methodology to be adopted. Adopting a systems approach can be a significant factor in ensuring that the maximum benefit is derived from the exercise. This approach focuses on the interaction between individuals and the systems within which they work. This can provide a more meaningful approach to understanding why the adverse event occurred, as it does not seek to blame individuals! An example of a systems thinking approach is the Chartered Institute for Ergonomics and Human Factors “Systems Engineering Initiative for Patient Safety Model”.

3. Keep reasonable hours

Healthcare providers involved in an adverse outcome often resolve that “this will never happen again” and pursue self-improvement to ensure it never will. However, this approach can be problematic when, in an effort to enhance performance, you demand even more of yourself (particularly working more hours). This can result in fatigue which may backfire and increase the likelihood of further adverse events.

4. Emphasise people skills

If you feel anxious, fearful, or dissatisfied, you might find it challenging to relate well to patients. These feelings can impair the doctor/patient relationship, which may adversely affect the mutual trust, critical to effective communication and good outcomes. Acknowledging these emotions and working to connect and engage with patients can help relieve such stress.

5. Identify your support systems

Your personal relationships may also suffer because of emotional distress. To address this, identify your support systems, ie, those with whom you can share your feelings and concerns without sharing specific information about the adverse patient outcome.

Expressing your personal feelings and concerns to one of your support systems, such as your spouse, a trusted friend, or a colleague, can help re-establish your emotional equilibrium.

6. Maintain a healthy work/life balance

Most people realise the benefits of maintaining a work/life balance. However, maintaining a “balanced” lifestyle is even more critical in this situation. At the very least, try to take care of your physical health. Consider how your eating habits, physical activity, sleep schedule etc. might affect a balanced lifestyle.

7. Monitor consumption of alcohol

Be cognisant that during times of emotional stress, some individuals have a tendency to improperly self-medicate or abuse alcohol. You may find it prudent to consult your own GP if the emotions resulting from an adverse patient outcome are significantly impacting your sense of wellbeing.

8. Seek professional help

Managing stress on your own is not always possible. You may need to seek professional help if you find you are struggling. We understand there is a widely recognised stigma amongst doctors around admitting the need for self-care and asking for help. If you are concerned about your wellbeing and wish to seek confidential professional advice, there are several organisations providing excellent resources and face-to-face help, such as:

• The GMC Doctor support service,
• BMA Wellbeing and support services,
• NHS Practitioner Health.

Resources

PMP commissioned Dr Suzy Jordache, an expert on the issue of Burnout, to write an article highlighting the key indicators and consequences of the phenomenon in, Avoiding Burnout, Enhancing Resilience.

The Second Victim Support website has numerous resources available, including Top tips for surviving the process after being involved in a patient safety incident.

If you are involved in a patient safety incident or receive a complaint from a patient, please call the PMP medicolegal helpline as soon as possible, in line with the terms and conditions of your policy. If you have any queries or concerns surrounding the issues raised in this risk tips document, please do not hesitate to call the PMP medicolegal helpline. The helpline is provided by our legal partners, Clyde & Co and is available 24/7, the number is on your customer card and your policy documents.