Helping staff who are traumatized by errors

In 2001, when Cheryl Connors was just three years into her career as a nurse, an 18-month-old girl named Josie King died as a result of medical errors on Connors' unit at Johns Hopkins Hospital.

Hospital administrators instructed nurses and physicians, who were traumatized by the little girl's death, not to discuss the case. They were left with no support and no way to work through their feelings. “Over the next year, I watched a lot of great nurses leave our unit and even leave the profession altogether,” Connors said. “The culture on our unit was swirling in the toilet.”

In the years that followed, she became deeply involved in efforts to make care safer at the hospital, rising to her current post as patient-safety specialist at the hospital's Armstrong Institute for Patient Safety and Quality. But her experiences following Josie's death stuck with her.

In 2010, she teamed up with Dr. Albert Wu, a professor of health policy and management at Johns Hopkins, to find a way to offer hospital staff needed emotional support following adverse events. In 2000, Wu wrote about the “second victim” phenomenon—a term that refers to the effects that medical errors have on caregivers and staff—in a widely read article in the journal BMJ.

After a medical error, employees may suffer from anxiety, shame and depression. The symptoms, if left unchecked, can progress to post-traumatic stress syndrome, Wu said. “It's evident that some people, months and years later, are still trying to avoid trigger situations or certain kinds of patients.”

Wu argues that hospitals need to provide support for stressed employees, not only because it's the right thing to do, but also because without such help, they are more likely to make mistakes on the job or leave their positions. There have even been cases of distraught caregivers who took their own lives after a medical error, he said.

An initial meeting to gauge interest in a support program drew nearly 60 people, including the hospital's vice president of medical affairs and other top administrators. Wu and Connors then assembled a team and spent several months discussing goals and developing training protocols. They also teamed with the Maryland Center for Patient Safety, which provided funding to create a training curriculum and materials that could be used in other facilities.

“What we ended up with was a volunteer peer-responder program whose sole mission was to provide timely support to staff who had encountered patient-related events and who could benefit from help,” Wu said.

In November 2011, the team launched a pilot of the program in the pediatrics department. Eighteen volunteers staffed a 24-hour pager and fielded several calls a month, Connors said. After seven months, they expanded the number of peer responders to 36 and implemented the program, known as RISE—resilience in stressful events—across the entire hospital. The program is separate from the hospital's root-cause analyses and other post-error patient-safety work, focusing solely on staff support.

RISE provides peer support, not counseling, Connors said. Volunteers are trained to offer more resources if employees need additional help after a phone conversation or in-person meeting. But in the vast majority of cases, that one interaction is enough to help them talk through their feelings, move forward and get back to work, she said.

One big challenge, Wu said, is helping staff understand that they can ask for support. “In healthcare, people feel like they should be dispassionate and suck it up,” he said. “And when an error occurs, they might not feel like they're deserving of help.”

Using the Johns Hopkins curriculum, two other hospitals, Greater Baltimore Medical Center and the University of Maryland Medical Center, recently launched peer-responder programs. Greater Baltimore has received four calls since its program began in March, said Carolyn Candiello, the hospital's vice president for quality and safety.

The Maryland Center for Patient Safety is in talks with several other hospitals that are interested in the program, now known as Caring for Caregivers, said Robert Imhoff, the center's CEO. Like the program at Johns Hopkins, Imhoff expects participating hospitals to see eventual improvements in employee turnover, employee satisfaction and measures of safety culture.

“I saw all of the things we do to foster employee satisfaction, like ice cream socials and pizza parties,” said Imhoff, a former hospital administrator. “That's all well and good. But nothing speaks to an employee like a program that says, 'We understand the tremendous strain you're under and we are here to support and care for you.' ”

Correction, July 23, 2015

A previous version of this story incorrectly stated the name of Greater Baltimore Medical Center.