Interventions in Europe to respond to the phenomenon of second victims


Patient safety is a priority for health systems around the world, despite this, around 9% of people admitted to hospitals and 2% of those in primary care suffer some adverse event (AE), affecting the healthcare professional and the patient. From this, the term arises “Second victims” is define as a “healthcare provider involved in an unanticipated adverse patient event, medical error and/or a patient-related injury who become victimized in the sense that the provider is traumatized by the event”. 

Now and since the past two decades, different interventions are being implemented in Europe to enhance the resilience of healthcare professionals in stressful situations for addressing this problem. However, the number of proved interventions in progress is scarce.

The worries and shame experimented with these events are some of the barriers that make it difficult to tackle this phenomenon, as well as preventing from engaging more actively in putting up barriers, speaking up or reporting adverse events, finally the patients are the biggest affected. In addition to very different legal schemes coexist,  barriers to speak-up about errors, mistakes, and mishaps and blame and shame cultures.

The objective of this investigation is to explore supportive interventions are being implemented in Europe to enhance the resilience of healthcare professionals in stressful situations and resulted in to implication of health authorities, healthcare workers, academics is needed, patient representatives, policymakers, and other stakeholders.


Through a cross-sectional study was conducted on an online survey in 82 academics and clinicians who had formalized their membership in the COST Action 19113 and members formally to ERNST by September 2020, representing 27 European and one neighboring country. The study period was from September 25 to December 15, 2020.

The survey explored the scientific profile of the participants, their interests, experiences in the topic, challenges, gaps, and related areas of second victims. In this study was conducted to know what, how, and where studies and interventions were being conducted in Europe in this issue.


A total of 70 members answered, 97.1% from European countries, these were Belgium, Bosnia and Herzegovina, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Lithuania, Malta, Moldova, Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland, Turkey and 2.9%from a neighbor country this is Azerbaijan. The 60.7% of participants reported the existence of patient safety standards that incorporate some form of care for professionals who experience the second victim symptoms. The 37.1% of researchers involved in this COST Action were conducting studies or research underway on second victims or related issues (15 countries). The 30% of the participants were being involved in the design of interventions aimed at addressing the second victim phenomenon. At the time of this survey the 42.9% of participants were participating in the implementation in health centers of any intervention aimed at addressing the second victim phenomenon.

Finally the survey reflecting the understanding of how increasing healthcare workers’ resilience is improving patient safety, however, efforts are further needed to consolidate a change in the culture of both society and healthcare institutions that will benefit the actions to achieve a safer environment for patients.

Patient safety and second victims’ topics  by partners of the ERNST Consortium (COST Action 19113)  by country

Study topicsCountry estudies: pilot study, assessment, analysis, research project, review, action, guidance document and public views
Frequency, nature, and causes of adverse eventsDenmark, France, Italy, Lithuania*, Portugal, Spain, Sweden and* The Netherlands
Nature and frequency of second victim responses. Psychosocial risks in the workplace. Well-being and resilience at workBelgium, Croatia, Germany, Italy with the participation of Belgium and Turkey, Slovakia and Spain
Second victim phenomenon and patient safety curricula in students and residentsBelgium, Germany*, Finland and Serbia
Literature reviews on second victims and management of adverse eventsBelgium*, Italy and others, Finland, Portugal and Spain
Good practices and recommendations after an adverse eventFinland, Portugal and Spain, German*, French*, Italian and Switzerland*
Patient safety culturePortugal and Norway*
Risk managementSerbia
Legal frameworkBelgium, Germany*, Iceland, Ireland* and Spain
The seconds victims of COVID-19Belgium, Germany, Slovakia and Spain
Terminology (appropriateness of the term second victim)Ireland
Design or implementation of support programs, interventions, and techniques to enhance resilience in stressful situationBelgium and The Netherland*, Denmark and Spain
Defensive medicine and second victims’ phenomenonItaly with the participation of Belgium and  Italy and Turkey
Patient safety perceptionsSpain and Sweden
Open disclosureBelgium and Spain
Aggressive behavior of patients toward healthcare professionalsIsrael

*No available data yet

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