Joint Commission advises hospitals to help staff after traumatic events

The Joint Commission issued an advisory report this week urging its accredited healthcare organizations to provide support services to staff after traumatic patient events.

Healthcare providers can experience psychological trauma when their patients experience adverse health events like an unexpected death or medical error. The emotional toll such events can have on providers has been coined "second victims" and although healthcare organizations have begun to address the issue, programs and tools haven't been widely adopted, according to the Joint Commission.

"We are trying to improve the awareness and importance of this issue," said Dr. Ana McKee, executive vice president and chief medical director of the Joint Commission.

In its advisory, which was sent out to the roughly 21,000 healthcare organizations it accredits, the Joint Commission offers various tactics for healthcare leaders to support staff after traumatic events. The commission recommends organizations create a culture that encourages communication about defects and errors, engage all team members to share lessons learned when an adverse event occurs and provide guidance to staff about how they can properly support each other during trauma.

"(Doing) nothing is not the right answer ... an organization has to find some approach to raise awareness about the second victim," McKee said.

The commission also offers ways for healthcare organizations to implement "second victim" programs. These programs provide peer-to-peer support services to staff and have been adopted at some hospitals and health systems across the country like Johns Hopkins University and Health System.

Rise, which was launched in 2011 at Johns Hopkins, is a 24/7 call center staffed by roughly 30 clinicians at the organization who have volunteered to be part of the program. The participants are trained in psychological first aid, a technique used to help victims debrief soon after a traumatic patient event.

"It's intended to be a safe (space for staff) — we don't report it to managers," said Dr. Albert Wu, a professor of health policy and management at Johns Hopkins who helped launched the program.

The program has encouraged staff at Johns Hopkins to be more open about their emotions, Wu said. Whole clinical teams will go together for support after a particularly traumatic event. "It is changing the culture," he said.

The Joint Commission took best practices from "second victim" programs like Johns Hopkins in its recommendations. Healthcare organizations are encouraged if they want to form such a program to obtain buy-in from leadership, emphasize the importance of patient safety and develop an educational campaign.

At Nationwide Children's Hospital, resources to establish the YOU Matter Second Victim Program were initially scarce.

Jenna Merandi, director of the "second victim" program, said she partnered with the marketing department to raise awareness. Informational messages were displayed on digital quality boards and Merandi and her team spoke at meetings across various departments.

"The first several years we didn't have funds, we started from the ground up," she said. "(After) we showed the value of the program and how it was changing the culture, we did receive funding and support."

YOU Matter Second Victim Program, which first launched in 2013, has now trained more than 700 Nationwide staff members to be peer supporters.

The Columbus, Ohio-based children's hospital has surveyed its staff on feelings of burnout and stress since the program has been in place, and the results are promising.

"We have been able to show the effectiveness of the program ... it's improving negative psychological impact on front line staff," she said.