A leading psychiatrist is demanding better support for Australian healthcare workers caught up in adverse patient events, arguing that tens of thousands of “second victims” are suffering in silence despite new workplace psychosocial hazard laws.

Sydney Local Health District psychiatrist Dr Sarah Michael highlighted the overlooked “second victim phenomenon” in the Medical Journal of Australia, urging organisations to do more to support staff after unexpected patient outcomes [link].

Second victims are healthcare workers affected by an adverse patient event, whether due to negligence or an unpreventable near miss, whose experience causes stress or trauma.

Dr Michael said those involved may experience a wide range of symptoms including shock, guilt, depression, grief, intrusive thoughts, nightmares, sleep disturbance, social withdrawal and doubts about their competence. Investigations into adverse events can compound that distress, she added, potentially leading to anxiety and burnout.

The scale of the problem is significant, she argued. Given that 6.4% of the 7.1 million hospital separations in Australia in 2022-23 were associated with an adverse event, that amounts to almost half a million adverse events each year. Hospital separations refer to when a patient leaves hospital through discharge, transfer or death.

Despite this, publicly available sources suggest there have been no notices or prosecutions under Australian workplace laws relating to “second victim” situations.

A 2022 shift in workplace law has put psychosocial harm in the spotlight. Safe Work Australia introduced psychosocial hazards into model health and safety laws, adopted by every state except Victoria, placing the onus on employers to eliminate or minimise such risks. But calls on healthcare managers to address workplace issues such as bullying and excessive hours have not extended to protecting staff after adverse events, Dr Michael argued.

Three steps to a restorative and just culture

Emerging evidence supports a “restorative and just culture” (RJC) approach, which takes a structured approach to supporting clinicians, patients and their families after harmful events.

Dr Michael outlined three tiers of support:

• Leadership and culture: staff and leadership co-develop a culture of psychological safety, with open incident reviews and formal follow-up after adverse events
• Peer support: trained colleagues provide help and referral to professional services
• Professional support: employee assistance programmes, chaplaincy and workplace mental health resources

“For too long healthcare workers have silently suffered as second victims of adverse events, and through investigations rooted in blame rather than learning and humanity,” Dr Michael said.

She argued that while workplace laws may drive broader organisational change, an RJC framework could help healthcare workers navigate these challenges while also supporting patients and families.