Reducing stress is an organisational imperative since workplace pressures continue to be one of the main causes of short and long-term absence. According to research undertaken by CIPD based on responses from 804 organisations, 79% of respondents report some stress-related absence in their organisation over the last year. Healthcare settings have an even higher rate of absence due to stress, yet there is reason to be optimistic that this could start to change when a new policy from NHS England is implemented, which recommends the use of After Action Review.

Reducing stress inflicted by ‘second victim harm’

Have you heard of the term ‘second victim harm’? It refers primarily to healthcare employees who are involved in an unanticipated adverse patient event, a medical error and/or a patient-related injury, and become victimised in the sense that the employee is traumatised by the event.

The term was first coined by Dr Albert Wu in 2000, in relation to patient harm after a physician error, but it has since been expanded to include the anxiety, depression and shame that any healthcare provider feels after any traumatic adverse or unexpected patient care experience.

Unsurprisingly, the incidence of disturbance increases with the degree of patient harm and the research suggests there are personal and career stage characteristics which may increase susceptibility. Research studies report extended recovery times and a range of disturbing and profound symptoms in the sufferers.

Researchers are also investigating what helps mitigate the harmful effect of patient safety incidents on healthcare staff. Whilst significant energies are and should be devoted to reducing adverse patient safety events in the first place, efforts to provide effective support to reduce second victim harm, will in themselves increase patient safety by reducing stress, staff turnover and absence.

Role of AAR in reducing stress

One of the organisations in the UK leading the support for clinicians is the Yorkshire and Humber Patient Safety Translational Research Centre (YHPSTRC) and Yorkshire and Humber Improvement Academy (YHIA). Their Organisational Staff Support Model (OSSM) is a very interesting approach to preventing and managing employee stress after Patient Safety Incidents (PSI), providing guidance for different interventions.

At the primary level they suggest the goal should be a “proactive supportive working environment to facilitate adaptive coping before and in the event of, being involved in a PSI – for example a just learning culture and psychological safety”. Similarly, a large study of young German doctors found that “support measures with an exceptionally high approval among second victims, were the possibility to discuss emotional and ethical issues, prompt debriefing after the incident and a safe opportunity to contribute insights to prevent similar events in the future.”

What is therefore clear to me is that the academic research now supports what we have understood for a long time from first-hand experience of using AAR: it plays a key role in reducing stress for those who have been involved in clinical incidents.

AAR on the front line

In one of the hospital trusts where I have trained clinicians to use AAR for team-based learning after events, I encountered Naser*, a neonatologist, who became one of the strongest advocates for the use of AAR within his department. An experience as a neonatal registrar had left him traumatised and he didn’t want anyone else to suffer like he had. A premature baby had died when he was on duty on the unit for the first time, and he suffered many weeks of guilt and anxiety as a result. It was only after the coroner’s inquest and report had been published that he was able to see that the cause of death was outside of his control.

Once he had experienced the AAR process, Naser saw it was exactly what was needed to ensure individuals could learn for themselves, in a more timely fashion, the many causes of adverse events and benefit from the peer to peer support. Naser recognised that the psychological safety and the opportunity to contribute to improvements in the future that the AAR creates, would help reduce the significant risk of second victim harm in his neonatal unit, where the experiencing of distressing events are a regular occurrence.

The research evidence also lends added weight to my claim that the soon to be published PSIRF (Patient Safety Incident Response Framework) will reduce second victim harms and staff absence. This is because it will be recommending the use of AAR as one of the preferred tools to enable a more proportionate response to patient safety events and improve the support to affected staff.

If you would like to learn more about how to build the AAR into your response to patient safety events, please do get in touch.

*Naser is not his real name