The Second Victim In Healthcare: Why Care For The Caregiver Programs Are Needed

My experience two weeks ago in Geneva, Switzerland with patient safety education colleague Susan Scott RN, MSN from the University of Missouri Health System was enlightening as she walked the audience through the level of commitment, engagement and support that can be achieved when a small team of people help lead an organization on the critical components of a Just Culture journey. The work becomes contagious for the organization, as others see the benefits and join the team, catalzying and accelerating the  journey. Susan’s presentation on Care for the Caregiver programs provided new ideas and energy to everyone in the room because of the example her health system is setting in creating a culture that supports care providers when things don’t go as planned. As Terry Fairbanks MD, MS and human factors engineering expert mentioned in his talk at NPSF and referred to here at, “A Miracle” on the Hudson: A Strong Case For Just Culture In Healthcare,  humans make mistakes, but in healthcare we have learned we can’t make mistakes. This irrational belief ensconced within medicine makes for a difficult recovery when errors inevitably occur, not only for us as care providers but for all involved–patients, families, and administrators as well.

Reprinted with permission of Susan Scott RN, MSN University of Missouri

According to Scott and colleagues, caregivers move through stages after an error occurs, similar to the stages of grief identified by Elizabeth Kubler-Ross – denial, anger, bargaining, depression and acceptance (see graphic at right). The culture of the organization in which that care provider works can have tremendous impact on how well that provider, and patient,  recover after an event. Susan noted that one of three resulting outcomes– thriving, surviving or dropping out–are experienced by care providers after harm occurs to one of their patients, and the outcome is often dependent upon how well the organization and support systems respond to that caregiver, also know as the Second Victim. In the past, the “wall of silence” strategy employed by hospital administrators and risk managers has silenced caregivers at times they most needed to talk about what occurred. Health systems with just cultures in place are able to support these providers, while at the same time, continue to connect with the patient and/or family members in a meaningful, caring and honest way.

As care providers, the willingness to admit our humanness, and thus our ability to make an error,  will help re-frame the recovery and learning process when an error does tragically occur. In the past, we have essentially left good people out to dry at a time they have most needed our support. Too many stories of good, caring healthcare providers who have gone as far as to take their own life after harming a patient senselessly compound medical errors. Model Care For the Caregiver programs like the one at the University of Missouri, can show us a better way, while at the same time, help us learn from these tragic events in a way that makes all of our health systems safer.


3 Comments on “The Second Victim In Healthcare: Why Care For The Caregiver Programs Are Needed”

  1. Kathy Torpie says:

    I agree, as human beings, clinicians can (and will) make errors and need support following errors that cause serious harm, just as family members need support. What is too often missing in this reasoning is the fact that many of the inevitable errors can (and should) be caught and stopped by others speaking out when they see an error about to be made. We are all responsible – including patients and family members – for speaking out when we see something being done (or not done) that could put the patient at risk. In a culture of trust this would be recognized as supportive behavior rather than as challenging the authority of a ‘superior’ who is expected (unrealistically) to never make mistakes. The culture of silence found in most medical organizations is not in the best interests of the patient OR of clinicians.

    • Kathy,
      I fully agree – why we all need to work on our organizational cultures so both near misses and unsafe conditions can be easily reported into an patient safety event occurrence management system for all of us to learn from. Efforts have started in many places, but the AHRQ Patient Safety Survey results show we have a long way to go. The category of fear in reporting errors (and near misses) is consistently ranked the lowest in survey results throughout the country.
      Thanks for your comment.

      • Kathy Torpie says:


        I believe that it is important first and foremost to catch and stop errors as they occur by speaking up at the time. If that begins to happen more, trust can be established that this is supportive rather than critical behavior. It will be easier to then report such incidents into a data base and, more importantly, discuss each and every incident openly to learn from it.

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