Lessons for leadership and culture when doctors become second victims: a systematic literature review

Abstract

This review set out to understand what leaders and organisational cultures can learn about supporting doctors who experience second victim phenomenon; the types, levels and availability of support offered; and the psychological symptoms experienced. A systematic review of keywords ‘Medical Error’ [MeSH], ‘Near Miss’, ‘Adverse Event’, ‘Second Victim’ and ‘Support’ was carried out using CINAHL Plus, Medline and Embase Classic and Embase 1947-2017 databases. Results show that poor organisational culture and leadership negatively influences and hinders doctors who make mistakes. Leaders who promote and create environments for open and constructive dialogue following adverse events enable the concept of fallibility and imperfection to be assimilated into new ways of learning. Guilt and fear are the most consistently reported psychological symptoms along with a perception of loss of professional respect and standing. Doctors often carry unresolved trauma for several years causing them to constantly relive an event. Unchecked, this can lead to poor relationships with colleagues and impact greatly on their ability to sleep and performance at work. The review concludes that a prevailing silence, exacerbated by poor organisational culture, inhibits proper disclosure to the first victim, the patient and family. It also impedes a healthy recovery trajectory for the doctor, the second victim. Leaders of organisations have a vital strategic and operational role in creating open, transparent and compassionate cultures where dialogue and understanding takes place for those affected by second victim phenomenon.