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It’s important not to overlook the impact of adverse events on the care team itself. Anyone involved in an error resulting in harm to a patient is likely to be affected, though their individual experiences and reactions may vary considerably. Health care provider organizations will want to have policies and procedures in place to ensure internal communications are prompt and effective when an adverse event occurs.

  • How can our organization offer support to the care team?

    Medically Induced Trauma Support and Services (MITSS) recommends the following approach when communicating with colleagues:

    • Let colleagues share their experience
    • Be patient and allow for silence
    • Express appreciation for sharing
    • Reflect, interpret, and summarize
    • Discuss coping strategies
    • Inquire about the colleague’s support systems
    • Ask permission to follow up, and get contact information
    • Verify if they are going to be okay
    • Offer to provide literature on emotional impact
    • Provide a resource list if possible
    • When in doubt, refer
  • How will we know if a member of our care team is struggling in the aftermath of an adverse event?

    Team members may have different reactions. Here are some signs to watch for:

    Psychological and Emotional

    • Depressed mood
    • Irritability
    • Loss of interest or pleasure
    • Drug or alcohol abuse
    • Feelings of inadequacy and loneliness
    • Loss of trust
    • Perceived indifference from colleagues
    • Anger, guilt, frustration Inability to think or concentrate
    • Recurrent images or thoughts of the event triggered by non-specific events
    • Distress when exposed to events that are reminders of the trauma
    • Hypervigilance
    • Desire to connect with others experiencing similar trauma

    Cognitive

    • Inability to think or concentrate
    • Feeling distracted

    Physical

    • Trouble eating or sleeping
    • Fatigue
    • Headaches

    Behavioral

    • Hyperactivity, or less activity
    • Drug or alcohol abuse
    • Social isolation
    • Insomnia or excessive sleeping
    • Strong need to talk about the event or read information surrounding the traumatic event
  • What are key elements of an effective support network within an organization?

    All health care organizations should be prepared to provide emotional support to their clinicians and staff members following an adverse event.

    According to MITSS:

    • Programs may take many forms, but some kind of support should be made available for all clinicians and staff members. Programs should be established as soon as possible and publicized widely, so that individuals know how to access help in the immediate aftermath of an event.

    • Clinician and staff support should be part of each institution’s operational response to adverse events.

    • Support programs must reflect the circumstances and culture of each institution. An institution may want to develop separate programs for different elements of the workforce. The kinds of programs that have proved to be helpful include:

    • Peer support (individual or group)
    • Employee assistance programs
    • Psychological and psychiatric counseling

    • Don’t assume that individuals whose involvement in the event seems peripheral will not experience stress and will not need support. Similarly, don’t prejudge what constitutes an “adverse” event. Managing these programs successfully means being observant and flexible about the needs of different individuals.

    • Pay especially close attention to clinicians who are involved in disclosure and apology discussions following adverse events. They may have urgent needs for support and may engage with patients and families more effectively if they, too, feel supported.

    • Support programs will not be successful without visible commitment from the institution’s executive and medical leadership.

    • Fear of legal action should not prevent someone from getting the emotional support they need following an adverse event. While clinicians should avoid discussing the details of the medical case and event outside of privileged communications with legal counsel, they may talk about their feelings without fear that those discussions will be used against them in court.

    • Clinician support programs may be characterized as protecting an institution’s investment in its workforce and supporting favorable return on investment. At this early stage, there is not much data available to support the business case for support programs, but a case can be made based on anecdotal evidence and common sense.

  • Where can we get help building a support program for staff?

    MITSS offers a free toolkit to help provider organizations build a clinic and staff support program. Customized onsite or remote services are also available to interested providers.