Suffering in silence: A qualitative study of second victims of adverse events

Susanne Ullström*, Magna Andreen Sachs, Johan Hansson, John Øvretveit, Mats Brommels

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

196 Citations (Scopus)


Introduction: The term 'second victim' refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient-the 'first victim'. The aim of this study was to investigate how healthcare professionals are affected by their involvement in adverse events with emphasis on the organisational support they need and how well the organisation meets those needs. Methods: 21 healthcare professionals at a Swedish university hospital who each had experienced an adverse event were interviewed. Data from semi-structured interviews were analysed by qualitative content analysis using QSR NVivo software for coding and categorisation. Results: Our findings confirm earlier studies showing that emotional distress, often longlasting, follows from adverse events. In addition, we report that the impact on the healthcare professional was related to the organisation's response to the event. Most informants lacked organisational support or they received support that was unstructured and unsystematic. Further, the formal investigation seldom provided adequate and timely feedback to those involved. The insufficient support and lack of feedback made it more difficult to emotionally process the event and reach closure. Discussion: This article addresses the gap between the second victim's need for organisational support and the organisational support provided. It also highlights the need for more transparency in the investigation of adverse events. Future research should address how advanced support structures can meet these needs and provide learning opportunities for the organisation. These issues are central for all hospital managers and policy makers who wish to prevent and manage adverse events and to promote a positive safety culture.

Original languageEnglish
Pages (from-to)325-331
Number of pages7
JournalBMJ Quality and Safety
Issue number4
Publication statusPublished - Apr 2014
Externally publishedYes


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