Second victims, organizational resilience and the role of hospital administration

Santomauro, Chiara; Kalkman, Cor J.; Dekker, Sidney

doi:10.5430/jha.v3n5p95

Cited by 23 publications

(28 citation statements)

References 71 publications

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“…Similar to patients, making a medical error negatively affected NPs’ well‐being and oftentimes left long‐lasting psychological scars. Overall, this evidence supports the notion that medical errors result in psychological harm to patients as well as caregivers (Gallagher, Waterman, Ebers, Fraser, & Levinson, ; Jones & Treiber, ; Santomauro, Kalkman, & Dekker, ; Scott et al., ; Waterman et al., ). Clearly, the narratives strongly suggest that NPs who err experience “second victim” phenomena.…”

Section: Discussionsupporting

confidence: 78%

Exploring the experience of nurse practitioners who have committed medical errors

Delacroix

2017

Journal of the American Association of Nurse Practitioners

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Background and purpose To explore the experience of committing medical error from the perspective of nurse practitioners (NPs). Overall, the purpose of the study is to discern NPs’ behaviors, perceptions, and coping mechanisms in response to having made a medical error. Methods Qualitative research based on two face‐to‐face audio‐recorded semistructured interviews with 10 NPs who had made medical errors in practice. The analysis was guided by concepts in phenomenology. Conclusions During iterative analyses, four overarching themes were identified: (a) The paradox of error victimization, (b) primacy of responsibility and mindfulness, (c) yearning for forgiveness and a supportive other, and (d) coping with a new reality is context dependent. The narratives strongly suggest that NPs who err experience “second victim” phenomena. Implications for practice Reminiscing about the experience of living through an error, NPs shared meaningful insights into their need for a safe environment in which they could candidly share feelings, reflect on the experience, and ascertain the etiology of the mistake. Debriefing in a formal manner might prevent the development of permanent psychological injuries. Hence, inherent to the care of “second victims” is the notion of co‐workers’ fairness, compassion, and recognition of appropriate caring responses that contribute to effective coping and healing.

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Section: Discussionsupporting

confidence: 78%

Exploring the experience of nurse practitioners who have committed medical errors

Delacroix

2017

Journal of the American Association of Nurse Practitioners

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“…[42] Striving for perfection is in accordance with the idea of medicine being a calling or vocation and may be reinforced through society's expectations of physicians, further influencing physicians' own expectations. [20] While it is important for physicians to be professional and strive for excellence in their work, the culture of medicine may, at times, foster unrealistic expectations and frame wellness as incongruent with professionalism. Holding high expecta-tions for oneself may be beneficial up to a certain point, after which these expectations may be overwhelming and lead to exhaustion or poor health.…”

Section: Discussionmentioning

confidence: 99%

“…[17] These stakeholders may be well served by mounting a joint effort at fostering physician resilience. [11,17,20] Before implementing programs to improve physician resilience, it is important to understand what resilience means to physicians in order to develop programs that resonate with physicians and encourage their participation in such programs.…”

Section: Introductionmentioning

confidence: 99%

The look and feel of resilience: A qualitative study of physicians’ perspectives

Polachek

Wallace

Gautam

et al. 2016

JHA

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Some physicians can effectively cope and thrive in the face of potentially stressful job conditions, while others experience serious, negative consequences. This ability to be resilient may improve physician wellness and benefit health care organizations, yet little is known about what resilience means to physicians. This paper explores how physicians understand resilience both as they observe it in their colleagues and as they experience it themselves. Semi-structured interviews were conducted with 32 physicians practicing in Alberta, Canada. Two questions explored physicians' experiences of resilience or non-resilience, while two other questions considered what they observed in physician colleagues. Interview transcripts were independently coded by two authors and discussed to ensure agreement on the key themes. There were several similarities in how physicians described resilience or non-resilience in themselves and their colleagues related to control, positivity or negativity, boundaries and balance, coping, and support. There were also important differences in how physicians described their own experiences and their observations of colleagues. Participants' portrayals of themselves suggested being immune to stress and responsible for their success or failure in being resilient. Their depictions of colleagues, however, focused on professionalism, work performance, commitment to values, and experience or wisdom. There appears to be a difference in how physicians understand resilience in themselves compared to what they observe in their colleagues. Specifically, physicians may hold unrealistic and unachievable expectations for their own resilience. Initiatives aimed at improving physician resilience and wellness may be best served by raising awareness about more realistic expectations and self-appraisals.

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“…[8,27,28] Moreover, compared to other companies with high-risk professionals, hospitals' investment in support for second victims is lagging. [29] This backlog may be related to the high standards set in the medical profession. Society, [30] patients and family, [15] and hospitals and colleagues [10] have great difficulties dealing with second victims' vulnerability.…”

Section: Introductionmentioning

confidence: 99%

The need and availability of support systems for physicians involved in a serious adverse event

Leferink

Bos²,

Heringa

et al. 2018

JHA

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Objective: Serious adverse events occur in healthcare, and do not solely have consequences for patients (first victims), but also affect physicians involved (second victims). These second victims experience diminished emotional well-being and less professional performance. An increasing number of hospitals organize support for second victims, although scientific evidence on the kind of support that is expected and needed is poor. This study therefore investigates support needs after serious adverse events from both personal (physicians) and organizational (quality and safety staff members) perspectives. Methods: We conducted semi-structured interviews in a Dutch university medical center. Physicians (N = 19) who had been directly involved in a serious adverse event participated. In addition, quality and safety staff members (N = 3) reflected on the support needs as expressed by physicians. Verbatim transcripts were three-fold coded, which led to several themes for our inductive thematic analysis. Results: Contrary to recent developments in healthcare organizations, participants did not plea for a hospital-wide support team. Acceptance of the emotional and professional impact of an adverse event by direct colleagues and supervisors is more important. Where such a cultural context is provided, physicians prefer support of a close and reliable colleague to cope with emotions and doubts, a supervisor who monitors recovery, and a healthcare organization that provides information about required procedures to learn from the events. However, this ideal was seldom found in the competitive working environment. This underlines the need for a shift from a competitive professional culture into a more supportive one. Conclusions: Ideally, direct colleagues support each other after an adverse event. This form of collegial support can only be successful if there is general acceptance of healthcare professionals' vulnerability and their support needs within the direct working environment. To create the right circumstances to meet these support needs, both healthcare professionals and hospital organizations have to recognize and take their responsibilities.

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Second victims, organizational resilience and the role of hospital administration

Cited by 23 publications

References 71 publications

Exploring the experience of nurse practitioners who have committed medical errors

Exploring the experience of nurse practitioners who have committed medical errors

The look and feel of resilience: A qualitative study of physicians’ perspectives

The need and availability of support systems for physicians involved in a serious adverse event

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