Blog Article: Peer Support and the Second Victim

By: Matt Norvell, Pediatric Chaplain, Johns Hopkins and Albert W. Wu, Director, Center for Health Services and Outcomes Research, Johns Hopkins

“I was trying to help….”
“Am I going to be fired? Or worse?”
“I can’t tell anyone about this.”
“Maybe I’m in the wrong profession.”

When things go wrong in healthcare, they can go really wrong, really fast. It might be an unexpected decompensation, a surgical complication, or a medical error. No matter what happens, every time something goes wrong, a healthcare provider is close by.

Healthcare providers show up to work every day with the intention of helping, and sometimes that means they end the day feeling as if they’ve failed or even harmed a patient.

When a patient is harmed in the course of their care, their family also suffers.  Together they are considered the First Victim of an adverse event.  The good news is that, although far from perfect, many hospitals and healthcare systems are doing as well as they ever have in disclosing errors to patients, advocating for patients, and caring for patients and their families after problems occur.

However, there’s also a Second Victim—the healthcare provider who intended to help, but wound up causing harm.1 The concept of a second victim originated in 2000 as Dr. Albert Wu reflected on his experience with a patient incident 15 years earlier. He knew that the young physician involved needed emotional support, which wasn’t provided.  Our hospital systems don’t adequately care for the mental and emotional health of the doctors, nurses and staff who dedicate themselves to helping others – and sometimes, inadvertently, cause harm.

There are so many ways healthcare providers can be emotionally damaged in the course of an average shift—feeling inadequate because of understaffing, being yelled at or even threatened by a patient or family member, facing an ethical dilemma in the course of patient care, witnessing (or participating in) an acute decompensation of a patient, or watching a beloved patient die. All of these events and more happen in the context of the rest of their lives—relationships, raising children, aging parents, financial challenges, sick pets, and flat tires.

Generally, when a healthcare provider feels like he or she is drowning under waves of pressure, responsibility, and surrounded by high expectations, our hospitals have failed to respond.  When they do pay attention, it’s often to tell people they should ‘focus on self-care’ and ‘avoid burnout’ without giving them the time or resources to accomplish these undefined expectations.

There is hope.

Across the country, hospitals have begun to implement peer support programs for their staffs. As providers and disciplines began to acknowledge their own weighty stories, hospitals have started to develop ways to support healthcare providers who have been emotionally wounded in the course of their work.  These programs aim to help clinicians who had been trained to ‘grin and bear it.’ They now acknowledge that unprocessed stressful events were causing them to be more distracted, less aware of the work in front of them, and even less able to provide the high-quality care they want to provide – and patients deserve.

In 2007, Sue Scott started the ForYou program at University of Missouri[1]. At about the same time, Dr. van Pelt helped develop a peer support program at Brigham Women’s and Children’s hospital[2]. And in 2011, a multidisciplinary team started the RISE (Resilience In Stressful Events) program at Johns Hopkins Hospital[3]. All of these programs are built to provide timely peer support for hospital employees who have experienced some sort of stressful clinically related event.

In 2014 Johns Hopkins partnered with the Maryland Patient Safety Center to develop and distribute a program called Caring for the Caregiver—Implementing RISE. In the five years since, we have helped 31 hospitals in 11 different states and two countries adapt and implement these programs for their particular contexts.

While this has always seemed like the right thing to do, this movement is gaining momentum. In 2018 the Joint Commission identified this type of support as a need and suggested (not yet mandated) every hospital have a program that focuses on supporting healthcare workers who have experienced an acutely stressful event at work.

In an effort to improve the safe provision of care, we are doing a better job supporting the people doing the work. There’s still work to do and we need to move forward aggressively to ensure patient and provider safety.

[1] Scott. SD., Hirschinger, LE., Cox, KR., McCoig, M., Hahn-Cover, K., Epperly, KM., Phillips, EC., Hall, LW., 2010. Caring for our own: deploying a system wide second victim rapid response team. The Joint Commission Journal on
Quality and Patient Safety
36(5), 233-240.

[2] van Pelt, F., 2008. Peer support: healthcare professionals supporting each other after adverse medical events. Quality & Safety in Health Care 17(4), 249-252.

[3] Edrees, H., Connors, C., Paine, L., Norvell, M., Taylor, H., Wu, A. “Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study”, BMJ Open 2016.