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Hot Off the Press: Perceptions of Institutional Support for “Second Victims” Associated with Safety Culture and Workforce Well-Being


By J. Bryan Sexton, PhD, and Kathryn C. Adair, PhD

Health care workers leave for work intending to be of service to their patients, but some return home knowing that their patients experienced harm. Good intentions, top-notch training and maximum effort do not prepare them for the difficult feelings that can follow from witnessing or being involved in patient harm. 

These feelings can range from guilt to anger, trauma, or questioning of career choice. Though the term second victim is problematic because many feel like the family members of the patient are the “second” victims of patient harm, many researchers call health care workers who have been traumatized by an unanticipated clinical event the second victims of that patient harm.  

Our patient safety officers at Duke University Health System, Durham, North Carolina, wanted to know the rates of health care workers that have experienced this scenario, but more importantly, they wanted to know the extent to which our people were getting the support they needed from their health system.

We didn’t have any of those numbers, so we decided to collect them the next time we embarked on our routine safety culture assessment to meet Joint Commission, Magnet and Leapfrog guidelines. The Duke Center for Healthcare Safety and Quality partnered with the patient safety officers and Safe and Reliable Healthcare (the survey vendor) to develop, refine and collect the two items related to second victim prevalence and the support they perceived from the health system.  

Our findings, in the May 2021 issue of The Joint Commission Journal on Quality and Patient Safety, showed that 36% knew at least one second victim, and of those 1 out of 4 health care workers reported that second victims did not get adequate support from the health system. In contrast, 42% of health care workers knew a second victim who did get support.

We note in the paper that feeling supported was a huge predictor of better:

  • well-being
  • trust in leadership
  • teamwork
  • capacity for doing quality improvement work
  • patient safety (most importantly)

In other words, using a simple addition of two items to a routine survey, we instantly knew what work settings and which groups of health care workers were not getting the support they needed in the aftermath of a horrible day at work. Institutional support for the well-being of health care workers was not ideal before the COVID-19 pandemic, but there is little doubt that resources to support workforce well-being are essential for health care workers today.

Using National Institutes of Health (NIH) funding (R01 HD084679-01) and progressive well-being programs over the past 10 years, we have developed and validated a diverse set of resources for health care workers, including:

The founding mother of this work is our friend and co-author Sue Scott, PhD, RN, who has also provided ample resources and generously shared her work at the University of Missouri. The most important takeaway from our research is that second victim support is an unmet need. When we do support second victims, they report profoundly better well-being, teamwork, leadership and patient safety. It’s also quite simply the right thing to do.

J. Bryan Sexton, PhD, is Associate Professor in the Department of Psychiatry at Duke University School of Medicine, and Director at the Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina.

Kathryn C. Adair, PhD, is Assistant Director at the Duke Center for Healthcare Safety Quality.