194-1172 / Improving healthcare approaches to support second victims

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
Hospital and primary care of the Spanish Health System


Professional learning program on quality and safety

GOP Description
Implementation level
Clinical settings
Hospitals and primary care centres
To make aware to healthcare managers of the second victim phenomenon in order they take on responsibilities
To encourage the implementation of actions to address the impact of AEs on second and third victims
To describe what interventions and precautions have been implanted for coping with the emotional response of second victims
Managers of hospitals and primary care. Health authorities of the Health Ministry and the autonomous health services in Spain.
Managers were surveyed to identify and analyse the approaches for coping with the impact of adverse events on the professionals.
The instrument included 45 interventions proposed for second and third victims, covering: alleviating the impact of AE on second victims; peer support or specialized counselling for second victims; training in patient safety; reducing the rate of AE; open communication with patients harmed by AE and/or their relatives; civil liability cover and legal advice offered to health professionals; procedures for reporting incidents and AE; methods for analysing the causes of AE; crisis management plans; distribution of responsibilities among managerial staff; and the organisation’s approach to communication in the event of an AE, as well as specific actions with residents. Each intervention was assessed regarding two issues: degree of implementation and potential useful. Both questions were scored on a 5-point Likert-type scale (none/very low, low, moderate, high or very high).
Timeframe implementation
We have needed 3 months to designed the questionnaire and 3 months to obtain information.
Implementation tools available
The questionnaire explores five intervention areas: safety culture; health organisation crisis management plans for serious AE; measures to ensure transparency in communication with patients (and relatives) who experience an AE; care and support for second victims; and actions to protect the reputation of the health organisation (the third victim).
Implementation cost
A total of 13,915 euros.
Method used to measure the results
A questionnaire was used to identify what is happened in hospitals and primary care. This instrument is available on http://www.biomedcentral.com/content/supplementary/s12913-015-0994-x-s1.docx
Deficient provision of support for second victims was acknowledged by 71 and 61 % of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organisations. The degree of implementation of second victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1)
Analysis of the results
Many Spanish health organizations do not have a second victim support in place to respond to serious AEs. These findings show the lack of awareness of second phenomenon by managers and safety patient coordinators of the Spanish health organisations.
Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
There is no specified text here
Describe the strategies used to overcome the barriers (If needed)
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Other information
Other information about the GOP that you would like to add (Link or attached document)

20150929120535327_266_GOP_Intervenciones Hosp AP.pdf