Second Victim Syndrome: Applying Evidence-Based Methodologies to Address Challenges Faced by the Healthcare Workers

Subject: Program Proposal for “You Are Not Alone” Intervention

The second victim syndrome is a real threat in many if not all healthcare institutions. Second Victim Syndrome is the result of unanticipated adverse outcomes of patients due to healthcare workers’ routine efforts to restore optimum health to their patients. Due to the nature of the medial error physicians as well as nurses can suffer severe psychological and emotional trauma due to what is usually perceived as an indictment on their professionalism and commitment. There are documented incidents of some physicians and nurses to mention but a few, committing suicide.

There are six (6) stages of recovery from the second victim syndrome according to Scott & McCoig (2016) and they are as follows:

1.     Chaos and accident response

2.     Intrusive reflections

3.     Restoring personal integrity

4.     Enduring the inquisition

5.     Obtaining emotional first aid and

6.     Moving on

The current report goes into detail to discuss each stage by giving the characteristic features of the each one. The report also seeks to present evidence-based second victim syndrome intervention strategy developed by the University of Missouri Healthcare System (MUHC). The intervention is known as Scott Three-Tiered Interventional Model of Second Victim Support.

A modified version of the MUHC second victim intervention model will be used to create a program for Alpha Hospital.

Current Research on Second Victim Syndrome

Second Victim Syndrome as it relates to healthcare workers is a traumatic event that often has a negative impact on the confidence of healthcare workers to practice (Scott & McCoig 2016). There are documented cases of physicians being unable to cope with the emotional impact of a medical error. In the event of a medical error, physicians as well as nurses are required to report the events as standard procedure demands but there are instances where healthcare workers perceive that their professionalism has been called into question (Stewart et al., 2015). The feeling of being targeted has far-reaching consequences for the healthcare worker in question (Scott & McCoig 2016).

According to a qualitative research conducted by Scott & McCoig (2016), there are six (6) stages of recovery for a healthcare worker following a medical error. The stages are: chaos and accident response, intrusive reflections, restoring personal integrity, enduring the inquisition, obtaining emotional first aid and moving on.

The Chaos and Accident Response stage begins a process of psychosocial symptoms as well as anxiety (Scott & McCoig 2016). At this stage, the healthcare worker begins a process of introspection and asks questions as to what went wrong, how things could have been done better and to some extent why the better options were not implemented. The intense scrutinization of the healthcare workers’ own errors tends to be the main source of anxiety.

The Intrusive Reflections stage is when the healthcare worker comes to a full realization of the impacts of an error on a patient. They tend to repeat the process leading up to the event in their mind and ask a series of questions which seek to help get a clear idea of what had taken place (Scott & McCoig 2016).

During the Restoring Personal Integrity Stage, the dominant emotion is fear. Healthcare workers at this stage of recovery tend to think their colleagues do not believe in their competence and ability to practice which can have negative consequences for the medical team as a whole. Doctors and nurses also fear the possibility of losing their jobs because they believe they cannot be trusted by their colleagues and that others have a generally negative perception of them due to committing a medical error.

After making a report and during an investigation, the clinician has to meet with many administrators and heads of departments. At this stage, the healthcare worker fears losing their license, their job and in some cases litigation. Even in cases where malpractice lawsuits have been filed and the litigation process has ended, some clinicians still have fear-related anxiety. After healthcare workers have interacted with heads of departments, they tend to both want and need emotional support except in some cases they tend to think they have few options to access (Scott & McCoig 2016; Stewart et al., 2015).

Healthcare workers resort to three main different strategies to move on from a clinical event that causes them to become second victims (Scott & McCoig 2016). The strategies identified by Scott & McCoig (2016) are dropping out, surviving, and thriving. The emotional impact of a medical error is sometimes so severe that some healthcare workers leave the profession, seek employment elsewhere and even in some extreme instances commit suicide just to end their plight.

Some optimistic healthcare workers still practice but post-event performance evaluations indicate that they are unable to return to pre-event performance levels (Scott & McCoig 2016). The most ideal of the three possible options to move on from a medical error is thriving. Healthcare workers who thrive after a medical error tend to learn from the experiences and play a role in creating corrective action plans to prevent a recurrence of the errors in the future (Scott & McCoig 2016).

Evidence-based interventions and evaluations

The University of Missouri Health Care system (MUHC) in 2009 developed an evidenced-based second victim intervention called the Scott Three-Tiered Interventional Model of Second Victim Support (Scott et al., 2010). The intervention was implemented by a team of fifty-one (51) members referred to as the forYOU  Team. Members of the team were drawn from specialties including but not limited to physicians, nurses, social workers, and respiratory therapists. Although each adverse patient event is unique and may require individualized intervention, each healthcare worker in identified to be in need of support goes through each stage of the three-tiered model.

            For Tier 1, team members are trained to recognize events that are likely to subject a healthcare worker to the second victim syndrome and to provide emotional first aid. Tier 2 provides continuing guidance for clinicians who have been second victims previously. Colleagues are readily available 24/7 and can be found at especially high-risk departments. The peers placed in the clinically high-risk departments provide one-on-one help.

Peers found in the high-risk departments tend to give referrals for counselling especially in cases where there is a protracted litigation process involving a clinician. Tier 3 involves counselling services for second victims of medical error. The third tier consists of chaplains, social workers, and clinical psychologists purposely for the provision of counselling services which go beyond the level of experience and competence of clinicians’ peers.

Out of forty-nine (49) Tier 2 rapid response activations, only 13 were escalated to Tier 3 for support. The number of escalations from one lower-level to the next is indicative of the level of impact the intervention has had on the second victims of unanticipated adverse patient outcome. Scott et al. (2010) did not mention the main means of evaluating the long-term, success of the program and that is a weakness of the program overall.

According to Hu et al (2012), when healthcare workers are emotionally and psychologically traumatized by unexpected adverse patient events, there is

 

New Program Proposal: You Are Not Alone (YANA)

The You Are Not Alone program is will consist of a forty-six (46) member panel which will provide rapid response support for clinicians within Alpha Hospital. The program is based on MUHC’s Scott Three-Tiered Interventional Model.

Tier 1 requires department or unit support from the managers, supervisors and fellow team members. The task of tier 1 team members is to provide one-on-one support and reassurance for colleagues who show signs of or have the potential to fall victim to the second victim syndrome. Tier 2 will consist of trained peers and risk managers who will give support to clinicians going through litigation procedures. Tier 3 will be made up of trained and experienced counsellors who will take the healthcare workers most at risk of opting for extreme measures to attain step six (6) of the recovery model. Tier rapid response team members will also have the added responsibility of being placed in very high-risk departments within the hospital such as the obstetrics and

Gynecology department.

Resources/Inputs	Activities	Outputs	Interim Indicators	Outcomes	Impact
-       Survey items -       Employee Assistance Program -       Chaplains -       Social Workers -       Clinicians	-       Interviews -       Conducting web-based surveys -       Monthly meetings of team members	- active involvement of peers in program	- increased number of healthcare workers participating in program - survey response rate -fewer escalation of cases to upper tiers	- well trained rapid response team	- reduced number of healthcare worker cases escalating through 3 tiers of Scott Three-Tiered Integrated Model

The You Are Not Alone Program (YANA) will have a weekly debriefing to share success stories about the interventions that have been completed as well as the challenges that face the team in the discharge of their duties. The purpose of weekly debriefings is to determine what has been successful and what methods have proved unsuccessful and to collectively determine the best path forward.

Potential risks involved with the program include non-participation by hospital staff in the program especially during the survey phase. Nonparticipation will yield no data and by extension no baseline by which the success of the program can be evaluated. In terms of rewards of the program for Alpha hospital, there will be a substantial reduction in the number of healthcare workers who decide to leave the facility to seek employment elsewhere due to a medical error they are responsible for and feeling that the management provides no support for them in times of crises. By implementing the program, employee turnover will be reduced or even avoided altogether and that can save the hospital some money over the long term

References

Scott, S. D., & McCoig, M. M. (2016). Care at the point of impact: Insights into the second‐victim experience. Journal of healthcare risk management, 35(4), 6-13.

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

Stewart, K., Lawton, R., & Harrison, R. (2015). Supporting “second victims” is a system-wide responsibility. BMJ, 350, h2341.