‘RISE’ to Support Second Victims in Health Care | Joint Commission
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This blog shares experiences, case studies and news that add insight and value to the accreditation and certification journey.

‘RISE’ to Support Second Victims in Health Care

Aug 31, 2017 | 1626 Views

norvell-headshot-2-copyBy Matt Norvell, MDiv, MS, BCC, NBCC
Pediatric Chaplain
Johns Hopkins Children’s Center

This blog post goes beyond the study, “Do Hospitals Support Second Victims? Collective Insights From Patient Safety Leaders in Maryland,” from the September 2017 issue of The Joint Commission Journal on Quality and Patient Safety. The post discusses a second victims program implemented at Johns Hopkins Hospital in Baltimore. 

“You know, I have thought about that event most days for the last 10 years. No one ever gave me the chance to talk about it.” 

Margaret had been a nurse on a pediatric unit. She was a part of a team taking care of a child that unexpectedly died. Eventually, it was determined the death was caused by a preventable medical error that had nothing to do with her nursing care. But she did not know this. 

In the first three years after the incident, Margaret never slept more than four hours at a time because she would wake up wondering what she could have done differently. Two years after the event, she left pediatrics and became a nurse in an adult nursing unit because taking care of other children reminded her that she might have made a fatal mistake. After about five years, she started to see a therapist and take prescription sleep medication, but still did not feel relief.

For over 10 years, Margaret, and many other members of the team taking care of the same patient, shouldered the burden of guilt and responsibility for the child’s death because they were not given an opportunity or invitation to talk about their experience.

Lingering Guilt
This situation is not unique. Every day in health care settings, something goes wrong, a mistake is made, or there is an unexpected negative outcome. In every one of these situations, there is a well-intentioned, compassionate, talented and loving health care provider who may experience emotional confusion, second guessing and guilt.

These feelings hijack the emotional and attentional energy that could be used to provide good care. “Second victims” are health care providers who are emotionally traumatized after an adverse patient event1  and often find themselves in need of support that health care settings do not traditionally or systematically provide.

Second Victims Program 
In 2010, we acknowledged that we were failing to offer appropriate support to second victims among our own staff at Johns Hopkins Hospital, Baltimore.

Like many institutions, we had several layers of support to offer our staff members, including:

  • managers with open door policies
  • mentors
  • wellness programs
  • employee assistance programs 
  • chaplains
  • social workers

However, none of these provided a specific invitation for: 

  • support tailored to individuals who experienced a stressful, patient-related event.
  • immediate and confidential support for employees by peer clinicians, known as “Peer Responders,” who are trained to show up and listen without judgement or an attempt to solve the problem.

Our program “RISE” (Resilience In Stressful Events), detailed in a new study from the September issue of The Joint Commission Journal on Quality and Patient Safety, started from scratch rather than as a re-tooling of existing programs. As we developed RISE, we worked diligently to build a form of support that people would feel comfortable using and willing to recommend. From the beginning, we have solicited and integrated feedback from our employees2

Challenges and Lessons Learned
One of our greatest challenges was to develop a consistent and effective way to train our Peer Responders so they would feel competent enough to provide support to the people who call for help. Our other primary, and ongoing, challenge is to build awareness of the program. In a large academic medical center, it is challenging to ensure those who need the program know about it.

We are aware that not everyone who faces a difficult event needs to use RISE. Most people who work in health care are generally resilient, especially as they have been through gauntlets of exams and certifications, advanced training and other life challenges. The challenge comes when an individual gets pushed beyond his or her normal scope of personal strength because of a particularly stressful event. These events can happen anywhere in a person’s life, but they are especially prevalent in health care. 

Unfortunately, the traditional response to a second victim (sometimes explicit, sometimes implicit) is that he or she needs to “suck it up” or that it is “a part of the job you have to learn to live with.” While these pieces of advice may work for some people, they do not work for everyone. Most of us, at one point or another, need someone who will take the time to listen to the emotions that are beyond what we face on an average day.

Three months after telling her story to our team, Margaret reached out and thanked us for giving her the chance to talk about her experiences and struggles since the event happened. She told us that after talking with us she began sleeping better than she had in 10 years. She said she cannot over emphasize how valuable it is to tell your story to a group of people whose only intention is to listen without judgment or an attempt to solve the problem.


1Wu, Albert W. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ 2000; 320:726.
2Edrees, H., Connors, C., Paine, L., et al. Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study. BMJ Open 2016;6:e011708. 

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