Addressing the Emotional Toll of Harmful Medical Events
We are all human. And as humans, while we strive to not commit errors, it can happen. The fact there are two victims of every error. One of them is, of course, the patient and their family. The second one has been identified as the staff who were involved with the event. Both groups require acknowledgment and need further research.
Preventable Medical errors continue to be a major cause of death in the USA and throughout the world. Of the 696 participants who filled out the survey for this study, 450 also provided written narratives that ranged from just a few words to several pages. Of these responses, 90% expressed concern over a lack of provider accountability. Patients and families indicated a belief the health systems and providers failed to respond appropriately to their suffering.
In addition, 47% of providers denied responsibility and 40% were secretive about the investigation; often excluding the family from anything but the results. And afterward, one-third of providers refused to communicate any further after the event. Many patients also said they were met with hostility when they offered feedback and additional information or asked questions. This study was conducted to relay to healthcare providers and administrators a first-hand view of the impact the adverse medical events has on patients and their families.
The biggest theme of the respondents to the survey was that providers and the health care system did not feel responsible or accountable for the harm the patients and family experienced. In addition, patients and families felt providers failed to effectively communicate with them both before and after the adverse event. And when providers did say something to the patients and family, it was disrespectful.
The study also showed that families and patients want to be part of the decision making process. The survey did also show that some respondents even made a number of suggestions for improvement. The take away from this survey is that patients and families want to be part of the decisions about their care (Southwick et al, 2015).
Errors or adverse events can result in negative outcomes for healthcare providers. The term, for this study, error or adverse event encompasses the broadest scope of mistakes, close calls, near misses, active errors or latent errors. It also includes incidents involving patient injury or harm resulting from medical care. While these events are detrimental for patients and their families, they can also have a profound negative impact on healthcare providers. These workers have verbalized significant emotional distress and diminished the professional quality of life as the result of an error or adverse event.
And due to the legal considerations, many providers are often unsure of who to turn to for support following the event. As an outcome of the 2000 Institute of Medicine report, medical error reporting has become more routine as well as an overall improvement in patient safety. This has also raised awareness of the second victim. According to the study the term second was devised to illustrate the necessity of giving support to doctors following a medical error. Later it was expanded to include all healthcare providers involved in an unanticipated adverse patient event, medical error and/or patient-related injury.
The study showed the second victims commonly experience significant emotional distress like anxiety, depression, and burnout. In addition, these can extend into the second victims' personal life and professional life leading to diminished professional confidence and causing a disconnect from patients. Most often the healthcare workers seek support from their coworkers who can help them learn from their mistakes. And the study found a significant level of anxiety. This is especially concerning as emotional distress can also negatively affect patient care (Winning et al, 2017)
Researchers at Beth Israel Deaconess Medical Center have been studying how medical errors can have a profound long-term effect on patients and families. One of their key findings was that there is a need to act now to prevent further emotional harm to patients. They identified 20 actions that were published in the Joint Commission Journal on Quality and Patient Safety. Some of the highlighted things from the list include the need to broaden the organizational approach to harm to include emotional harm. Involve patients and families in developing solutions and support access to care by taking steps to address health care aversion after harmful events.
They also identified a need to develop patient initiatives so they can speak up with clinicians getting involved with a listening initiative. There is a need to establish a network t foster healing through human contact to encourage sharing of strategies and support. In addition, the researchers found there was a need for longer-term research to be conducted to better support harmed patients and families. And that a lack of transparency after a medical error is a form of disrespect; withholding information can compound the harm (Bell et al, 2018).
Few programs recognize that adverse events can also produce emotional hardship for professionals involved. Awareness needs to be raised in the professional community about this issue: We have too few nurses as it is. Safety incidents associated with clinical errors not only have an emotional impact on patients but also in the health professional thought to be involved in them. These health professionals are often referred to as the second victim. These victims feel like they are emotionally overwhelmed and lose confidence in their abilities.
Presently a third victim has been identified. This third victim is seen as the healthcare organization as safety incidents may damage the reputation of and reduce trust in the healthcare organization. Mitigating the impact of these incidents in patients, the health organization and professionals are the responsibility of managers and middle managers in the organization. It is their job is to not only prevent the same issue from reoccurring but to create a proactive approach for safety and create conditions to alleviate their impact.
Among second victims, fear from legal consequences and fear of damage to their professional reputation are frequently reported. In addition, the study reported feelings of guilt and doubts of their own abilities for making clinical decisions and mood swings were frequent. Among professionals, there is still a fear of disclosing what happened to patients due to the legal ramifications. In the US and Canada, it has been estimated between 30% and 43% of professionals have experienced a negative emotional response following an incident. In addition, a recent study conducted in Australia, 76% of professionals involved in either a near miss or adverse event were seen to be emotionally affected by the incident.
Help for second victims is not part of the planned actions when an incident affecting patient safety happen in hospitals. An external evaluation found the entire research project website as a health website and was awarded it the level of Advanced Accreditation. Its strengths were related to identifying recipients’ usability, confidentiality, privacy, transparency, and honesty. Those who made use of the website increased their knowledge on patient safety terminology prevalence and impact of adverse events and errors, support models for the second victim and the recommended actions following a severe adverse event. Mitigating Impact in Second Victims (MISE) has shown to increase knowledge among health professionals about second victim phenomenon (Mira et al, 2017).
Bell, S.K. et al. (2018). Healing After Harm: Addressing the Emotional Toll of Harmful Medical Events. The Joint Commission Journal on Quality and Patient Safety.doi:10.1016/jciq.2018.03.007
Mira, J.J. et al. (2017). The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers’ Emotional Response After a Clinical Error. Journal of Medical Internet Research, 19(6).doi:10.2196/jmir.7840
Southwick, F.S., Cranley, N.M., Hallisy, J.A. (2015). Patient-initiated Voluntary Online Survey of Adverse Medical Events: The Perspective of 696 Injured Patients and Family. BMJ Quality & Safety. http://dx.doi.org/10.1136/bmjqs-2015-003980
Winning, A. M., Meurendi, J.M., Lieve, D., Stepney, LMC, Lio, N.N., Fortney, CA, Gerhardt, C.A. (2017). The Emotional Impact of Errors or Adverse Events on Health Care Providers in NICU: The Protective Role of Coworker Support. Journal of Advance Nursing.doi:10.1111/jan.13403