Perceptions of Institutional Support for "Second Victims" Are Associated with Safety Culture and Workforce Well-Being.

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This study was performed to determine whether health care worker (HCW) assessments of good institutional support for second victims were associated with institutional safety culture and workforce well-being.


HCWs' awareness of work colleagues emotionally traumatized by an unanticipated clinical event (second victims), their perceptions of level of institutional support for such colleagues, safety culture, and workforce well-being were assessed using a cross-sectional survey (SCORE [Safety, Communication, Operational Reliability, and Engagement] survey). Safety culture scores and workforce well-being scores were compared across work settings with high (top quartile) and low (bottom quartile) perceptions of second victim support.


Of the 10,627 respondents (81.5% response rate), 36.3% knew at least one work colleague who had been traumatized by an unanticipated clinical event. Across 396 work settings, the percentage of respondents agreeing (slightly or strongly) that second victims receive appropriate support ranged from 0% to 100%. Across all respondents, significant correlations between perceived support for second victims and all SCORE domains (Improvement Readiness, Local Leadership, Teamwork Climate, Safety Climate, Emotional Exhaustion, Burnout Climate, and Work-Life Balance) were found. The 24.9% of respondents who knew an actual second victim and reported inadequate institutional support were significantly more negative in their assessments of safety culture and well-being than the 42.2% who reported adequate institutional support.


Perceived institutional support for second victims was associated with a better safety culture and lower emotional exhaustion. Investment in programs to support second victims may improve overall safety culture and HCW well-being.





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Sexton, J Bryan, Kathryn C Adair, Jochen Profit, Judy Milne, Marie McCulloh, Sue Scott and Allan Frankel (2021). Perceptions of Institutional Support for "Second Victims" Are Associated with Safety Culture and Workforce Well-Being. Joint Commission journal on quality and patient safety, 47(5). pp. 306–312. 10.1016/j.jcjq.2020.12.001 Retrieved from

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John Bryan Sexton

Associate Professor in Psychiatry and Behavioral Sciences

Bryan is the Director of the Duke Center for the Advancement of Well-being Science.  He leads the efforts around research, training and coaching, guiding quality improvement and well-being activities.  


A psychologist member of the Department of Psychiatry, Bryan is a psychometrician and spends time developing methods of assessing and improving safety culture, teamwork, leadership and especially work-force well-being.  Currently, he is disseminating the results from a successful NIH R01 grant that used RCTs to show that we can cause enduring improvements in healthcare worker well-being. 


A perpetually recovering father of four, he enjoys running, using hand tools on wood, books on Audible, and hearing particularly good explanations of extremely complicated topics.

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