Interventions in health organisations to reduce the impact of adverse events in second and third victims

José Joaquín Mira, Susana Lorenzo, Irene Carrillo, Lena Ferrús, Pastora Pérez-Pérez, Fuencisla Iglesias, Carmen Silvestre, Guadalupe Olivera, Elena Zavala, Roberto Nuño-Solinís, José Ángel Maderuelo-Fernández, Julián Vitaller, Pilar Astier, on behalf of the Research Group on Second and Third Victims

Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims. A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution's reputation (the third victim). A total of 406 managers and patient safety coordinators replied to the survey. 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 organizations. Regarding third victim initiatives, 35 % of hospital and 43 % of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34 % of cases. The degree of implementation of second and third 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) (p < 0.001). Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs.