Patient safety professionals as the third victims of adverse events

Harm from adverse events does not always stop with patients and their families. In recent years, attention has been drawn to the plight of second victims, the healthcare workers involved in an incident, who can also experience significant harm. But even that does not tell the whole story. This article describes how those with indirect exposure to an adverse event can become the third victims of an adverse event, and focuses on the example of patient safety professionals responsible for incident investigation and improvement activities. We outline potential sources of harm, including critical incident stress, emotional labor, abusive supervision, and competing loyalties/duties. These stressors may cause symptoms of acute stress disorder or post-traumatic stress disorder, loss of confidence, and economic harm, and may even lead patient safety professionals to leave the profession. We also propose a number of actions to prevent or reduce harm to third victims, which include extending second victim support services to patient safety professionals, redesigning the patient safety role, providing board-level and senior management leadership, creating a culture of psychological safety, and tracking metrics related to third victims. Having drawn attention to this problem, we hope the research community will move forward with an agenda to more robustly characterize the sources and types of harm third victims experience, and to test interventions aimed at preventing and mitigating that harm.