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Albert Wu is Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and a practising clinician at Johns Hopkins Hospital, Baltimore. He has extensive research interests in patient safety and has published over 390 papers in the areas of quality, patient safety and clinical outcomes. He is credited with coining the term ‘the second victim’, an acknowledgement that when things go wrong in healthcare, the clinician suffers too.

It was on this subject that Prof Wu spoke recently at the inaugural Quality, Clinical Risk and Safety Conference, organised by the clinical risk team, State Claims Agency, in Dublin Castle on 12 September 2016.

The Second Victim

Prof Wu describes healthcare as a high risk industry for both patients and staff. Whilst acknowledging that the patient is the primary victim of a medical error, there is a growing realisation that healthcare staff members additionally are victims in that they too are traumatised. The event and its aftermath, colleague’s reactions, the subsequent investigation and potential litigation may be devastating for the healthcare provider. Prof Wu describes the carer being ‘bumped’ out of their ‘resilient zone’ leading to anxiety and panic on the one hand and numbness and depression on the other. Post-traumatic stress disorder (PTSD) can develop when such symptoms intensify, persist for more than a month and include flashbacks to the event. Even in the absence of PTSD, second victims are often left with feelings of incompetence, inadequacy or guilt.

In his landmark 2000 article for the British Medical Journal, Prof Wu commented that it is often the most dedicated and sensitive healthcare workers who are most at risk of injury from their own mistakes. At the conference, he relayed the 2010 story of a Seattle nurse, Kimberly Hiatt, who administered an overdose of medication to a baby who later died. Despite reporting the error herself, Nurse Hiatt was dismissed by her employer and subsequently took her own life. Prof Wu commented that there is a need for a different type of institutional response to such a tragedy, one which includes support for the staff member involved.


Prof Wu outlined the Resilience in Stressful Events (RISE) programme which he has pioneered at the Johns Hopkins Hospital. The idea is simply to provide care to the care-givers. RISE is confidential, non-judgemental and provides peer-to-peer support from a dedicated group of volunteers. The volunteers provide emotional ‘first-aid’ to second victims who are having trouble coping with their emotions following an adverse patient event. As Prof Wu emphasised, front line staff need to know that it is safe to talk about patient safety.

Caring for the Caregivers in Ireland

There are signs of a growing awareness of the importance of providing appropriate care for second victims in Ireland. The HSE in association with the State Claims Agency has produced a booklet entitled ‘Supporting staff following an adverse event: The ‘ASSIST ME model’ and has a free Employee Assistance Programme.

In addition, the State Claims Agency (SCA), the Health and Safety Authority (HSA) and Critical Incident Stress Management (CISM) Network Ireland worked collaboratively to produce a new and innovative psychosocial risk assessment framework, Work PositiveCI, with specific guidance for dealing with critical incidents and / or traumatic events in healthcare workplaces (please refer to the news & events section). This was piloted and validated in a number of healthcare locations. This framework is the first of its type in Europe and HSE human resources together with the SCA hope to implement it on a phased basis for frontline healthcare staff in 2017. For more information please contact


Prof Wu’s vision and compassion has shown that healthcare institutions can respond to adverse patient events in a way that supports patients and staff alike. His RISE programme builds resilience and provides peer support for healthcare workers who find themselves in stressful situations. It is reassuring to note that the plight of second victims is now recognised in Ireland. Initiatives, such as Work PositiveCI, which address this area are welcome and are integral to building a genuine culture of patient safety in Ireland.

References available upon request.

Article By: Mark McCullagh, Clinical Risk Adviser, State Claims Agency

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