When a patient is harmed by a clinical error, the focus is necessarily on healing those who survive and on helping the families of those who do not. But patient safety advocates say there is often a “second victim” — the physician or nurse involved. Clinicians responsible for a medication error, wrong-site surgery or other serious medical misstep can be left traumatized. Hospital leaders should provide thoughtful, integrated programs to help them cope with the aftermath of such events, says Miriam Marcus-Smith, R.N., program director of the Washington Patient Safety Coalition.

Marcus-Smith says a recent survey conducted by the coalition found that only four of 21 hospitals in Washington state have a formalized second victim support program. But every hospital that experiences an adverse event likely has a clinician who is emotionally suffering because of it, she says.

“Second victims often don’t realize that’s what they are,” says Marcus-Smith. “They tend to just deal with it on their own and try not to ask for help.” After suffering an adverse event during knee surgery, patient Linda Kenney founded Medically Induced Trauma Support Services in 2002, to help patients and clinicians who are suffering trauma after similar incidents. MITSS has developed a toolkit to help hospitals support caretakers suffering as second victims.

Kenney says many hospitals already have all the means they need in-house. It’s just a matter of getting leadership to buy in, scanning what’s available in the organization, convening a committee to discuss better practices, and integrating all those services.

“We all know how siloed everything is in health care and in hospitals,” Kenney says. “This is a way to bridge those gaps.

”That’s what officials are trying to do at Seattle Children’s Hospital, where they’re bringing all available supports into one formal second-victim support program, says Jackie Valentine, patient safety director.

Hospitals must be proactive about treating trauma among clinicians, whether by sending out surveys, conducting safety debriefings or asking quality leaders which employees might be at risk, Valentine says.

Physicians may feel more comfortable opening up to their peers, so Valentine recommends using doctors as counselors. She has seen physicians break down and leave the profession after causing patients serious harm.

“It’s hard to get people past that immediate reaction of ‘Oh, I’ll be fine. I’ll get over it.’ A lot of times they don’t recognize that they’re having a problem,” Valentine says.

“They’re losing sleep, they’re irritable, they’re just not themselves and they’re constantly running it through their minds. So, it’s important to try to normalize that it’s OK to seek help.”