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Does One Size Fit All? Assessing the Need for Organizational Second Victim Support Programs

Edrees, Hanan H. DrPH, MHSA*†; Wu, Albert W. MD, MPH*‡

doi: 10.1097/PTS.0000000000000321
Original Article: PDF Only

Objective Second victims are health care providers who are emotionally traumatized after experiencing an unanticipated patient's adverse event. To support second victims, organizations can provide a dedicated support program for their workers. The aim of this study was to assess the extent of the second victim problem in acute care hospitals in the state of Maryland, the availability of emotional support services, and the need for organizational support programs.

Methods In-depth, semistructured interviews were conducted with 43 patient safety representatives from 38 acute hospitals in Maryland. Data were analyzed using QSR NVivo10 software and a mixed-methods approach to generate codes and extract themes from the interviews. Descriptive statistics were generated for hospital and participant characteristics.

Results The response rate was 83% of hospitals. All participants reported that they and their executives were aware of the second victim problem. Although participants varied in their perceptions of whether a dedicated second victim support program would be helpful for their hospital, all thought that hospitals should offer organizational support programs. Several organizations are attempting to promote a “just culture” in responding to events, and there continues to be stigma associated with speaking up during a root cause analysis, and with accessing support if it were offered.

Conclusions The second victim problem is recognized in all hospitals in Maryland. However, even when support is available, health care providers face stigma and other barriers in accessing it. Future efforts should assess the need for second victim programs from the perspectives of second victims themselves to identify barriers and improve uptake of needed support.

From the *Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; †Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; and ‡Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland.

Correspondence: Hanan Edrees, DrPH, MHSA, Johns Hopkins University Bloomberg School of Public Health, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Quality Management Department, Ministry of National Guard Health Affairs, PO Box 22490, MC 2307, Riyadh 11426, KSA (e-mail:;

The authors disclose no conflict of interest.

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