Support for second victims

Leading the change we want to see

Wednesday, November 1, 2017 – Annette Down

Kimberly Haitt was a second victim. As a Critical Care nurse at Seattle Children’s Hospital, Haitt was involved in the accidental overdose of an eight-month old baby with ten times the prescribed dose of calcium chloride. She was ultimately dismissed from the organization, committing suicide seven months after the incident[1].

While it’s a heartbreaking story, the reality is that when a patient safety incident occurs and a patient suffers harm, they are not the only one who is impacted. Healthcare providers involved in incidents leading to serious injury or death may suffer emotional trauma. These individuals are also at high risk for burnout, self-harm and may leave the profession.

The term ‘second victim’ was coined by Dr. Albert Wu – an American physician. Wu drew attention to this problem and highlighted the need for better support for healthcare providers in the immediate aftermath of patient safety incidents.

The role of leadership

Healthcare leaders play a pivotal role in creating cultures where staff feel like they are being treated with respect and are supported in the aftermath of a patient safety incident. The support healthcare providers receive ultimately impacts staff outcomes and the culture of the organization.

Leaders should establish an organizational expectation that “anything less than a supportive response is unacceptable”[2]. This support could include:
  • Implementing a ‘just culture’ policy and building an environment where healthcare providers are comfortable speaking up
  • Ensuring access to counselling (e.g. employee assistance program or trained peer supports)
  • Identifying and addressing unsupportive or critical colleagues
  • Coaching on how to interact with and disclose the incident to the patient and family
  • Undertaking an assessment of the current climate with respect to supporting second victims
  • Creating awareness of the realities of second victims
At Central Health in Newfoundland, Tracy MacDonald, Risk and Patient Safety Manager, knows that kindness and compassion go a long way. MacDonald presented on the health authority’s work to train peer supports earlier this year at the Atlantic Learning Exchange in Charlottetown. Her key message was that treating healthcare providers who have been involved in traumatic patient safety incidents with respect is the primary goal.

Aside from feelings of guilt, second victims may also worry about the risk of litigation. But recent research by Mello and colleagues indicates that communication with a patient and family after a patient safety incident – with an apology, as appropriate – does not increase the likelihood of a lawsuit[3].

The impact of a patient safety incident may remain with a healthcare provider for years. Leaders have a critical role in ensuring second victims feel supported and that patient safety cultures are maintained or improved in the aftermath of incidents.

To request a copy of the Risk Note on Second Victims, please contact us at

By Annette Down, Senior Risk Management Specialist, HIROC


[3] Mello M, Kachalia A, Roche S, et al. (2017). Outcomes in two Massachusetts hospital systems give reason for optimism about communication-and-resolution programs. Health Aff. 36(10):1795-1803.