The Second Victim...

Posted by Jeremy Windsor on Feb 21, 2020

Have you been a "Second Victim?" If you've worked in health care for any length of time there's a good chance that you have been. At the 2020 Hathersage Mountain Medicine Festival, Carl Betts will be outlining his own experience of being the "Second Victim" and describing how he and others have learnt from the experience. Here's Carl to tell us more...

"As a paramedic, I work independently and am often required to make difficult decisions. For those like myself who are lone responders on a Rapid Response Vehicle (RRV) this is particularly difficult as we are often alone at scene with no other clinical assistance. With decisions there is always a risk that clinical errors can occur and any number of concerns or complaints can be raised against us. The consequences of these can have a profound impact on our clinical performance and future decision making, mental health and general self-confidence. This impact is now widely known as the, "Second Victim".

A request to visit your manager and being presented with a complaint effectively brings your clinical practice into question and causes instant personal anguish. Added to this, the information that your actions may have caused harm or distress to a patient in your care, causes even greater pain.  No one comes to work to cause this and every decision that we make is with the patient’s best interest at heart.

As with all health care organisations any complaint or concern needs to be actioned in a timely manner and in a way that follows local policies and procedures to ensure that standards of patient care are maintained at the highest level. Further to this, it is essential that any learning points highlighted during the investigative process are disseminated to staff so as to prevent similar occurrences from happening again.

Historically, the mentality of dealing with complaints or clinical errors in the ambulance service was with an "old school" attitude that used a "big stick approach" to ensure that those involved were made to feel guilty until proven innocent. Thankfully, this is changing into a wider and more thoughtful approach that looks at all the factors that may play a part in the concern raised. This not only includes human factors, but also an understanding of issues within the wider organisation that may have also been responsible.

In 2017-18, 98,300 complaints were made about primary care services in England. More than 80,000 were directed at specific staff. Recognising the importance of the "Second Victim" is a vital part of dealing with complaints in a positive and effective manner

A new addition to investigations is a concept called the “Second Victim”. I thought it was a very interesting concept when I first read about it but then parked it away and did not think much more of it. However, the day I was called into my manager’s office and informed of a complaint made against me, my journey as a "Second Victim" began.

In a nutshell, the "Second Victim" approach accepts that once a complaint has been made against an individual, that person automatically becomes a victim in their own right. Throughout the whole investigative process I was aware that there had been a noticeable deterioration in my clinical performance. I felt angry and anxious that I was being investigated which then affected my home life and my 2 weeks leave that coincided with the investigation.  Throughout the investigation I wasn’t sleeping well and became very insular. Due to my inability to concentrate properly I was aware that my clinical judgement was impaired. This was proven when in the same time period another concern was raised about me. I had worked in the ambulance service for 7 years and had never any form of complaint or concern raised against me. I can only put this subsequent issue down to the pressure and stress of the initial process. This in turn increased my anxiety and made me very conscious that I was at a high risk of making further errors which would then necessitate another investigation. Sadly, this caused a cascade of further worry and concern.

Since this incident and my awareness of "The Second Victim", I am now very much more aware of the detrimental impact that being investigated can have on personal performance, mental health and the wider effects upon family members. It is hugely important that we understand this and offer support. My talk is all about recognising the importance of the "Second Victim" and what can be done to help."

Carl will be giving his talk "The Second Victim - A Personal Perspective" at the 2020 Hathersage Mountain Medicine Festival on Monday 8th June.

Carl is a Paramedic and Quality Improvement Advisor at Yorkshire Ambulance Service. He was born and raised in Hartlepool where he developed a keen interest in many outdoor activities ranging from climbing to skiing and fell running. When time allows he assists the Hartlepool Lifeboat Crew with their casualty management training in order to get his hit of home air!

When not at work or working away in his shed, he spends time with his family enjoying the many delights of living in the heart of the Peak District. 

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