Supporting second victims of patient safety events: shouldn't these communications be covered by legal privilege?

Adverse events that harm patients can also have a harmful impact on health care workers. A few health care organizations have begun to provide psychological support to these Second Victims, but there is uncertainty over whether these discussions are admissible as evidence in malpractice litigation or disciplinary proceedings. We examined the laws governing the admissibility of these communications in 5 states, and address how the laws might affect participation in programs designed to support health care workers involved in adverse events. We found that privilege is uneven from state-to-state, and also unclear. Ambiguity alone could have a chilling effect on Second Victim programs. We propose legislation to protect volunteer and health care worker communications provided by peer counselors, or failing this, updating of statutory provisions to explicitly include these communications within the ambit of existing protections. Enhancing protections could help to foster an environment of healing for both patients and caregivers.

ReCASTing the RCA: an improved model for performing root cause analyses.

The root cause analysis (RCA) process is used to investigate adverse events. However, it may not reduce the risk of recurrence as effectively as intended. The authors propose adapting a risk prioritization and reduction process modeled after the Commercial Aviation Safety Team (CAST). The process involves the following: (a) increasing effectiveness of selected interventions by prioritizing each cause/contributing factor based on its role in the current sentinel event as well as in future events; interventions are then selected based on their ability to remediate the root causes/contributing factors and the likelihood of successful implementation; (b) measuring effectiveness of intervention implementation; and ( c) evaluating effectiveness of the interventions by measuring the rates of event recurrence, near misses, contributing factors, mitigating factors, and staff perceptions of risk. Teams that evaluate intervention effectiveness are independent of those that implement the intervention. This framework seeks to improve the RCA process and provide further insights into advancing patient safety.