Does One Size Fit All? Assessing the Need for Organizational Second Victim Support Programs.

OBJECTIVE: Second victims are health care providers who are emotionally traumatized after experiencing an unanticipated patient's adverse event. To support second victims, organizations can provide a dedicated support program for their workers. The aim of this study was to assess the extent of the second victim problem in acute care hospitals in the state of Maryland, the availability of emotional support services, and the need for organizational support programs. METHODS: In-depth, semistructured interviews were conducted with 43 patient safety representatives from 38 acute hospitals in Maryland. Data were analyzed using QSR NVivo10 software and a mixed-methods approach to generate codes and extract themes from the interviews. Descriptive statistics were generated for hospital and participant characteristics. RESULTS: The response rate was 83% of hospitals. All participants reported that they and their executives were aware of the second victim problem. Although participants varied in their perceptions of whether a dedicated second victim support program would be helpful for their hospital, all thought that hospitals should offer organizational support programs. Several organizations are attempting to promote a "just culture" in responding to events, and there continues to be stigma associated with speaking up during a root cause analysis, and with accessing support if it were offered. CONCLUSIONS: The second victim problem is recognized in all hospitals in Maryland. However, even when support is available, health care providers face stigma and other barriers in accessing it. Future efforts should assess the need for second victim programs from the perspectives of second victims themselves to identify barriers and improve uptake of needed support.

The Association Between Wait Times and Patient Satisfaction: Findings From Primary Health Centers in the Kingdom of Saudi Arabia.

BACKGROUND: It is no doubt that longer wait times can affect patient care and patients' willingness to seek health-care services. Not only does this disrupt the continuity of treatment and care, but it also negatively impacts patient outcomes. During the past few years, the concept of patient satisfaction has become a vital component in assessing the delivery and efficiency of care. Patient satisfaction is a performance indicator that measures the extent to which patient is content and satisfied with the level of care provided by health-care institutions and providers. Therefore, this research examined association between the wait times and patient satisfaction in selected primary health-care centers in Al Qassim region in the Kingdom of Saudi Arabia. METHODOLOGY: A patient satisfaction questionnaire was administered to 850 patients, which collected patient perceptions on the delivery of care at health-care centers in Al Qassim City. Outcome measures included wait times for: registration and payment, seeing the physician, performing radiation and assays, and dispensing the medications. RESULTS: The response rate was 72.94% (n = 620). The study found that 27.90% of the participants stated that the wait time to see the physician ranged between 21 and 30 minutes. Overall patients were mainly dissatisfied for wait times in relation to medication dispensation, vital signs measurement, dental consultations, and radiological investigation. The study found a positive association between the patient satisfaction and their education, marital status, and job. A significant regression equation was established between the patient satisfaction and age-group and literacy. CONCLUSION: The study advocated the need for recent technology, sufficient staffing, and patient-centered friendly methods to reduce wait times.

Second victims in the labor ward: Are Danish midwives and obstetricians getting the support they need?

OBJECTIVE: To describe midwives' and obstetricians' experiences on the level of support from colleagues and managers in Danish labor wards following adverse events. DESIGN, SETTING AND PARTICIPANTS: A 2012 National survey of Danish obstetricians and midwives was conducted to assess the level of support received in the workplace. MAIN OUTCOME MEASURES: Scales on social community at work, social support from colleagues and immediate superiors, and use of support mechanisms on labor wards after serious adverse events were assessed. RESULTS: 2098 midwives and obstetricians were invited to complete the survey (response rate 59%), and the analyses were carried out on the 593 respondents who had been involved in at least one traumatic childbirth at their current place of work. Respondents experienced high levels of social support from colleagues and social community at work, midwives significantly higher than obstetricians, and 95% of respondents had talked to colleagues about an adverse event. Respondents generally experienced low levels of social support and feedback from immediate superiors, and only 49% had talked to their immediate superior about an adverse event. Fifty% believed that the hospital had a clear process through which they could report adverse events, and 44% knew how to access the necessary confidential emotional support at work. CONCLUSIONS: Midwives and obstetricians experienced high levels of social support and feedback from colleagues who are the most frequent individuals to consult after adverse events. We strongly suggest developing second victim support programmes with a focus on offering peer support from qualified and trained peers.

Case: A Second Victim Support Program in Pediatrics: Successes and Challenges to Implementation.

PURPOSE: While there is growing attention to making health care safer, there has been less emphasis on helping health care workers to cope with stressful patient related events (these workers are commonly referred to as second victims). We used the RISE (Resilience In Stressful Events) peer support program at the Johns Hopkins Hospital as a case study for evaluating effectiveness, and identifying barriers to addressing the needs of second victims. DESIGN AND METHODS: The study used a mixed-method approach that included: 1) quantitative analysis of surveys of health care workers in the Department of Pediatrics before RISE implementation and four years after, and 2) content analysis of open-ended commentaries about respondents' experience with seeking second victim support, as well as feedback on RISE. RESULTS: Survey response rates were 22.4% and 23.3% respectively. Quantitative analysis showed that respondents at the later time point were more likely to contact an organizational support structure, and had greater awareness of the availability of support. Respondents were very likely (93%) to recommend RISE to others. Content analysis identified barriers to using RISE: overcoming blame culture, need to promote the initiative, and need for more staff time to handle adverse events. Respondents reported varied preferences for the support format and specific support interventions. CONCLUSIONS: The mixed-method approach allowed a comprehensive evaluation of RISE and provided some evidence for its effectiveness in supporting pediatric health care workers. PRACTICE IMPLICATIONS: The findings suggest an important role of organizational culture in second victim support program implementation and evaluation.

Examining influences on speaking up among critical care healthcare providers in the United Arab Emirates.

OBJECTIVE: Assess perceived barriers to speaking up and to provide recommendations for reducing barriers to reporting adverse events and near misses. DESIGN, SETTING, PARTICIPANTS, INTERVENTION: A six-item survey was administered to critical care providers in 19 Intensive Care Units in Abu Dhabi as part of an organizational safety and quality improvement effort. MAIN OUTCOME MEASURES: Questions elicited perspectives about influences on reporting, perceived barriers and recommendations for conveying patient safety as an organizational priority. Qualitative thematic analyses were conducted for open-ended questions. RESULTS: A total of 1171 participants were invited to complete the survey and 639 responded (response rate = 54.6%). Compared to other stakeholders (e.g. the media, public), a larger proportion of respondents 'agreed/strongly agreed' that corporate health system leadership and the health regulatory authority encouraged and supported error reporting (83%; 75%), and had the most influence on their decisions to report (81%; 74%). 29.5% of respondents cited fear of repercussion as a barrier, and 21.3% of respondents indicated no barriers to reporting. Barriers included perceptions of a culture of blame and issues with reporting procedures. Recommendations to establish patient safety as an organizational priority included creating supportive environments to discuss errors, hiring staff to advocate for patient safety, and implementing policies to standardize clinical practices and streamline reporting procedures. CONCLUSIONS: Influences on reporting perceived by providers in the UAE were similar to those in the US and other countries. These findings highlight the roles of corporate leadership and regulators in developing non-punitive environments where reporting is a valuable and safe activity.

Do Hospitals Support Second Victims? Collective Insights From Patient Safety Leaders in Maryland.

BACKGROUND: Second victims-defined as health care providers who are emotionally traumatized after a patient adverse event-may not receive needed emotional support. Although most health care organizations have an employee assistance program (EAP), second victims may be reluctant to access this service because of worries about confidentiality. A study was conducted to describe the extent to which organizational support for second victims is perceived as desirable by patient safety officers in acute care hospitals in Maryland and to identify existing support programs. METHODS: Semistructured interviews (using existing and newly developed questions) were conducted with 43 patient safety representatives from 38 of the 46 acute care hospitals in Maryland (83% response rate). RESULTS: All but one of the responding hospitals offered EAP services to their employees, but there were gaps in the services provided related to timeliness, EAP staff's ability to relate to clinical providers, and physical accessibility. There were no valid measures in place to assess the effectiveness of EAP services. Participants identified a need for peer support, both for the second victim and potentially for individuals who provide that support. Six (16%) of the 38 hospitals had second victim support programs, which varied in structure, accessibility, and outcomes, while an additional 5 hospitals (13%) were developing such a program. CONCLUSION: Patient safety officers thought their organizations should reevaluate the support currently provided by their EAPs, and consider additional peer support mechanisms. Future research is needed to evaluate the effectiveness of these programs.

Implementing the RISE second victim support programme at the Johns Hopkins Hospital: a case study.

BACKGROUND: Second victims are healthcare workers who experience emotional distress following patient adverse events. Studies indicate the need to develop organisational support programmes for these workers. The RISE (Resilience In Stressful Events) programme was developed at the Johns Hopkins Hospital to provide this support. OBJECTIVE: To describe the development of RISE and evaluate its initial feasibility and subsequent implementation. Programme phases included (1) developing the RISE programme, (2) recruiting and training peer responders, (3) pilot launch in the Department of Paediatrics and (4) hospital-wide implementation. METHODS: Mixed-methods study, including frequency counts of encounters, staff surveys and evaluations by RISE peer responders. Descriptive statistics were used to summarise demographic characteristics and proportions of responses to categorical, Likert and ordinal scales. Qualitative analysis and coding were used to analyse open-ended responses from questionnaires and focus groups. RESULTS: A baseline staff survey found that most staff had experienced an unanticipated adverse event, and most would prefer peer support. A total of 119 calls, involving ∼500 individuals, were received in the first 52 months. The majority of calls were from nurses, and very few were related to medical errors (4%). Peer responders reported that the encounters were successful in 88% of cases and 83.3% reported meeting the caller's needs. Low awareness of the programme was a barrier to hospital-wide expansion. However, over the 4 years, the rate of calls increased from ∼1-4 calls per month. The programme evolved to accommodate requests for group support. CONCLUSIONS: Hospital staff identified the need for a multidisciplinary peer support programme for second victims. Peer responders reported success in responding to calls, the majority of which were for adverse events rather than for medical errors. The low initial volume of calls emphasises the importance of promoting awareness of the value of emotional support and the availability of the programme.

The experiences of risk managers in providing emotional support for health care workers after adverse events.

Risk managers often meet with health care workers who are emotionally traumatized following adverse events. We surveyed members of the American Society for Health care Risk Management (ASHRM) about their training, experience, competence, and comfort with providing emotional support to health care workers. Although risk managers reported feeling comfortable and competent in providing support, nearly all respondents prefer to receive additional training. Risk managers who were comfortable listening to and supporting health care workers were more likely to report prior training. Health care organizations implementing second victim support programs should not rely solely on risk managers to provide support, rather engage and train interested risk managers and provide them with opportunities to practice.

Risk managers' descriptions of programs to support second victims after adverse events.

Guidelines call for healthcare organizations to provide emotional support for clinicians involved in adverse events, but little is known about how these organizations seek to meet this need. We surveyed US members of the American Society for Healthcare Risk Management (ASHRM) about the presence, features, and perceived efficacy of their organization's provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services. Provider support programs should enhance referral mechanisms and peer support, critically appraise the role of employee assistance programs, and demonstrate their value to institutional leaders.

Implementing a multifaceted intervention to decrease central line-associated bloodstream infections in SEHA (Abu Dhabi Health Services Company) intensive care units: the Abu Dhabi experience.

OBJECTIVE To determine whether implementation of a multifaceted intervention would significantly reduce the incidence of central line-associated bloodstream infections. DESIGN Prospective cohort collaborative. SETTING AND PARTICIPANTS Intensive care units of the Abu Dhabi Health Services Company hospitals in the Emirate of Abu Dhabi. INTERVENTIONS A bundled intervention consisting of 3 components was implemented as part of the program. It consisted of a multifaceted approach that targeted clinician use of evidence-based infection prevention recommendations, tools that supported the identification of local barriers to these practices, and implementation ideas to help ensure patients received the practices. Comprehensive unit-based safety teams were created to improve safety culture and teamwork. Finally, the measurement and feedback of monthly infection rate data to safety teams, senior leaders, and staff in participating intensive care units was encouraged. The main outcome measure was the quarterly rate of central line-associated bloodstream infections. RESULTS Eighteen intensive care units from 7 hospitals in Abu Dhabi implemented the program and achieved an overall 38% reduction in their central line-associated bloodstream infection rate, adjusted at the hospital and unit level. The number of units with a quarterly central line-associated bloodstream infection rate of less than 1 infection per 1,000 catheter-days increased by almost 40% between the baseline and postintervention periods. CONCLUSION A significant reduction in the global morbidity and mortality associated with central line-associated bloodstream infections is possible across intensive care units in disparate settings using a multifaceted intervention.

Health care workers as second victims of medical errors.

INTRODUCTION: "Second victims" are health care providers who are involved with patient adverse events and who subsequently have difficulty coping with their emotions. Growing attention is being paid to making system improvements to create safer health care and to the appropriate handling of patients and families harmed during the provision of medical care. In contrast, there has been little attention to helping health care workers cope with adverse events. OBJECTIVES: The aim of the study was to emphasize the importance of support structures for second victims in the handling of patient adverse events and in building a culture of safety within hospitals. METHODS: A survey was administered to health care workers who participated in a patient safety meeting. The total number of registered participants was 350 individuals from various professions and different institutions within Johns Hopkins Medicine. The first part of the survey was paper-based and the second was administered online. RESULTS: The survey results reflected a need in "second victim" support strategies within health care organizations. Overall, informal emotional support and peer support were among the most requested and most useful strategies. CONCLUSIONS: When there is a serious patient adverse event, there are always second victims who are health care workers. The Johns Hopkins Hospital has established a "Second Victims" Work Group that will develop support strategies, particularly a peer-support program, for health care professionals within the system.

A Simple Method for Causal Analysis of Return on IT Investment.

This paper proposes a method for examining the causal relationship among investment in information technology (IT) and the organization's productivity. In this method, first a strong relationship among (1) investment in IT, (2) use of IT and (3) organization's productivity is verified using correlations. Second, the assumption that IT investment preceded improved productivity is tested using partial correlation. Finally, the assumption of what may have happened in the absence of IT investment, the so called counterfactual, is tested through forecasting productivity at different levels of investment. The paper applies the proposed method to investment in the Veterans Health Information Systems and Technology Architecture (VISTA) system. Result show that the causal analysis can be done, even with limited data. Furthermore, because the procedure relies on overall organization's productivity, it might be more objective than when the analyst picks and chooses which costs and benefits should be included in the analysis.