An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management.

The concept of second victims (SV) was introduced 20 years ago to draw attention to healthcare professionals involved in patient safety incidents. The objective of this paper is to advance the theoretical conceptualization and to develop a common definition. A literature search was performed in Medline, EMBASE and CINAHL (October 2010 to November 2020). The description of SV was extracted regarding three concepts: (1) involved persons, (2) content of action and (3) impact. Based on these concepts, a definition was proposed and discussed within the ERNST-COST consortium in 2021 and 2022. An international group of experts finalized the definition. In total, 83 publications were reviewed. Based on expert consensus, a second victim was defined as: "Any health care worker, directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury and who becomes victimized in the sense that they are also negatively impacted". The proposed definition can be used to help to reduce the impact of incidents on both healthcare professionals and organizations, thereby indirectly improve healthcare quality, patient safety, person-centeredness and human resource management.

Nordic responses to Covid-19: Governance and policy measures in the early phases of the pandemic.

This paper explores and compares health system responses to the COVID-19 pandemic in Denmark, Finland, Iceland, Norway and Sweden, in the context of existing governance features. Content compiled in the Covid-19 Health System Response Monitor combined with other publicly available country information serve as the foundation for this analysis. The analysis mainly covers early response until August 2020, but includes some key policy and epidemiological developments up until December 2020. Our findings suggest that despite the many similarities in adopted policy measures, the five countries display differences in implementation as well as outcomes. Declaration of state of emergency has differed in the Nordic region, whereas the emphasis on specialist advisory agencies in the decision-making process is a common feature. There may be differences in how respective populations complied with the recommended measures, and we suggest that other structural and circumstantial factors may have an important role in variations in outcomes across the Nordic countries. The high incidence rates among migrant populations and temporary migrant workers, as well as differences in working conditions are important factors to explore further. An important question for future research is how the COVID-19 epidemic will influence legislation and key principles of governance in the Nordic countries.

[Professional versus public attitudes towards criminal charges in healthcare - registered nurses and a random national panel compared: Dark clouds on the horizon?]

INTRODUCTION: The aim of this study is to encourage a discussion on patient safety and public responses to serious incidents in healthcare. Triggered by the first of its kind in Iceland, it addresses the question what characterizes attitudes towards criminal charges for a serious incident in healthcare. MATERIAL AND METHODS: In this comparative study we examined whether attitudes towards culpability of healthcare professionals differed between cohorts from a random national panel and registered Icelandic nurses. Both groups were asked whether a healthcare professional should face criminal charges if causing serious harm or death due to human error, accident, neglect or intent. Answers were given on a Likert scale. RESULTS: When asked if a healthcare professional causing serious harm or death due to human error or by accident should face criminal charges, nurses were significantly more likely to somewhat or strongly disagree, while the panel was significantly more likely to somewhat or strongly agree. The difference was inversely proportional to educational levels among the panel members. When asked whether a healthcare professional should be charged for causing serious harm or death due to neglect or intent, there was no significant difference between the groups. CONCLUSION: The results indicate that healthcare professionals, as represented by Icelandic nurses, do not seek to avoid accountability in serious patient incidents, but implicate the importance of distinguishing between the different nature of incidents. The results show that a more informed public debate on serious health-care incidents is needed in which appropriate measures protecting patient safety as well as professional safety are ensured.

Iceland: health system review.

This analysis of the Icelandic health system reviews the developments in its organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy at birth is high and Icelandic men and women enjoy longer life in good health than the average European. However, Icelanders are putting on weight, more than half of adult Icelanders were overweight or obese in 2004, and total consumption of alcohol has increased considerably since 1970. The health care system is a small, state centred, publicly funded system with universal coverage, and an integrated purchaser provider relationship in which the state as payer is also the owner of most organizations providing health care services. The country's centre of clinical excellence is the University Hospital, Landspitali, in the capital Reykjavik, which alone accounts for 70 percent of the total national budget for general hospital services. However, since 1990, the health system has become increasingly characterized by a mixed economy of care and service provision, in which the number and scope of private non profit and private for profit providers has increased. While Iceland's health outcomes are some of the best among OECD countries, the health care system faces challenges involving the financial sustainability of the current system in the context of an ageing population, new public health challenges, such as obesity, and the continued impact of the country's financial collapse in 2008. The most important challenge is to change the pattern of health care utilization to steer it away from the most expensive end of the health services spectrum towards more cost efficient and effective alternatives. To a large degree, this will involve renewed attempts to prioritize primary care as the first port of call for patients, and possibly to introduce a gatekeeping function for GPs in order to moderate the use of specialist services.

Iceland: health system review

This analysis of the Icelandic health system reviews the developments in its organization and governance, health financing, health care provision, health reforms and health system performance. Life expectancy at birth is high and Icelandic men and women enjoy longer life in good health than the average European. However, Icelanders are putting on weight (more than half of adult Icelanders were overweight or obese in 2004) and total consumption of alcohol has increased considerably since 1970. The health care system is a small, state-centred, publicly funded system with universal coverage, and an integrated purchaser–provider relationship in which the state as payer is also the owner of most organizations providing health care services. The country’s centre of clinical excellence is the University Hospital, Landspitali, in the capital Reykjavik, which alone accounts for 70% of the total national budget for general hospital services. However, since 1990, the health system has become increasingly characterized by a mixed economy of care and service provision, in which the number and scope of private non-profit andprivate for-profit providers has increased. While Iceland’s health outcomes are some of the best among OECD countries, the health care system faces challenges involving the financial sustainability of the current system in the context of an ageing population, new public healthchallenges (such as obesity) and the continued impact of the country’s financial collapse in 2008. The most important challenge is to change the pattern of health care utilization to steer it away from the most expensive end of the healthservices spectrum towards more cost-efficient and effective alternatives. To a large degree, this will involve renewed attempts to prioritize primary care as the first port of call for patients, and possibly to introduce a gatekeeping function for GPs in order to moderate the use of specialist services.