Nav: Home

Healing after harm: Addressing the emotional toll of harmful medical events

August 22, 2018

BOSTON - Injuries and deaths resulting from medical errors can have profound long-term consequences on patients and families. Seriously harmed patients and/or family members who have lost a loved one may describe feelings of neglect, isolation, fear, anger, and despair, among other emotions, many of which can be heightened by organizational silence and withholding of information.

To date, quality improvement programs have largely focused on preventing more easily seen and measured physical harms, and little is known about the emotional and psychosocial harm stemming from medical errors and adverse events. Yet emerging data suggest that these secondary impacts may be just as harmful, or even more injurious, than the underlying event.

Now, a multidisciplinary group of leaders from the Healing After Harm Conference Group, led by Sigall Bell, MD, Researcher at Beth Israel Deaconess Medical Center (BIDMC) and Linda Kenney, Executive Director of Medically Induced Trauma Support Services (MITSS), has established a consensus-driven research agenda with both immediately actionable and longer-term research strategies for health care organizations. The research agenda, designed to create a path forward to inform approaches that better support harmed patients and families, was published online by the Joint Commission Journal on Quality and Patient Safety last month.

The team of four stakeholder groups - including patients and family advocates, clinicians and researchers, social scientists and policy experts, and healthcare foundation leaders - came together at an Agency for Healthcare Research and Quality conference to develop a research agenda for moving the field forward, and in doing so, identified 20 actions that are immediately implementable by hospitals and health care institutions and designed to prevent further emotional harm to patients and families experiencing adverse events and medical errors.

"One of our key findings was that we need to act now; we cannot wait several years for research to be completed while patients and their families are suffering," said Melinda Van Niel, MBA, CPHRM, Project Manager in Patient Safety at BIDMC, who played a pivotal role in helping run the conference. "We outlined 20 of these 'do now' actions that clinicians and organizations can begin working on today. Health care organizations have heightened urgency not only to prevent these events, but also to better support patients and families experiencing medical harm - and the actionable 'do now' approaches can help spearhead that effort."

Some highlights from the 'do now' recommendations include:
  • Broaden the organizational approach to harm to include emotional harm,

  • Involve patients and families in developing solutions,

  • Support access to care by taking steps to address health care aversion following harmful events,

  • Develop patient "speak up" initiatives and clinician "listen up" initiatives,

  • Establish a patient liaison, adapt existing tools for psychological support, and/or connect harmed patients through social networks to foster healing through human connection, being heard, sharing of strategies, and support,

  • Link clinicians and efforts focused on emotional harm, quality improvement, burnout reduction, respect and dignity, and culture change to synergize work, conceptual connections, and urgency.

The research agenda, including the full list of the 20 'do now' recommendations, is available online at the following link:

In addition to the immediately actionable interventions, the group also identified longer-term research strategies that will inform approaches that better support harmed patients and families. The stakeholder groups readily identified four shared priorities for research: establish patient-centered language for describing harm, reflecting what matters most to patients; describe the epidemiology - how often and in what ways - patients and families experience emotional harm; determine how to make emotional harm and long-term impacts visible to health care organizations and society at large; and lastly, develop and implement best practices for emotional support of harmed patients and families.

Lastly, several recurrent themes emerged from the conference. One of the more sobering lessons that materialized is that harm extends beyond the patient and can have far-reaching implications including negative impacts on family, social networks and community health. Another insight garnered from the conference is that lack of transparency after medical error is a form of disrespect - and that withholding information can compound harm. Finally, Bell and colleagues determined that emotional, psychological and social impacts following harmful events can last for years, and there's urgency to act now.

"Medical errors are a significant cause of death and injury in the U.S.," said Bell, who is also an Associate Professor of Medicine at Harvard Medical School. "Research on this topic is sparse despite the fact that the emotional toll of harmful medical events on patients and families can be severe and protracted, in some cases lasting for years and changing patient and family lives dramatically. As structured programs spread across the country to improve organizational responses to medical errors and adverse events, our findings highlight the critical gap in fully understanding the patient experience and the underlying need to create a roadmap for how to address this gap."
In addition to Bell, co-authors included Melinda Van Niel, MBA, CPHRM, Barbara Sarnoff Lee, MSSW, Elizabeth Lowe, all of BIDMC; Jason M. Etchegaray, PhD, of RAND Corporation; Elizabeth Gaufberg, MD, MPH, of the Arnold P. Gold Foundation; Kenneth E. Sands, MD, MPH of the Hospital Corporation of America; Eric J. Thomas, MD, MPH, Madelene J. Ottosen, PhD, RN, of UT Houston-Memorial Hermann Center for Healthcare Quality and Safety; and Linda Kenney of Medically Induced Trauma Support Services.

This work was funded by an Agency for Healthcare Research and Quality conference grant, R13HS024463. Additional support was provided by The Risk Authority, Stanford; Medically Induced Trauma Support Services; and Beth Israel Deaconess Medical Center.

Beth Israel Deaconess Medical Center

Related Social Networks Articles:

New method to rapidly map the 'social networks' of proteins
Salk scientists improved upon a classic approach to mapping the interactions between proteins.
Hormone-influenced social strategies shape human social hierarchy, study shows
In a game of chicken, the most aggressive players are fueled by testosterone and are more willing to harm others; and while it may be easy to demonize such hawkish behaviors, psychology researchers from The University of Texas at Austin say there is sound evolutionary reason for their existence.
Key friendships vital for effective human social networks
Close friendships facilitate the exchange of information and culture, making social networks more effective for cultural transmission, according to new UCL research that used wireless tracking technology to map social interactions in remote hunter-gatherer populations.
Are social networking sites good platforms for providing social support?
A critical review of 10 years of research on social support via social networking sites led to the identification of current trends and the development of recommendations to guide future research.
UTA works with Boeing and NASA to understand social networks' impact on online students' grades, completion rates
Researchers at the University of Texas at Arlington are working with Boeing and NASA to better understand the role that social networks play in the completion rates and academic performance of students taking online courses.
Multi-social millennials more likely depressed than social(media)ly conservative peers
Compared with the total time spent on social media, use of multiple platforms is more strongly associated with depression and anxiety among young adults, the University of Pittsburgh Center for Research on Media, Technology and Health found in a national survey.
Research provides new insights on the impact of wild birds' social networks
New research looks into how social networks among wild great tits, as they forage in flocks during the winter, carry over into shaping the set locations at which the birds breed and raise their young during the spring.
How friendship networks at college impact students' academic and social success
Student friendships at college can be classified into three types of networks: tight-knitters, samplers and compartmentalizers and should not be underestimated, according to a Dartmouth study 'Friends with Academic Benefits,' published in the current issue of Contexts, which examines how these type of friendships can either help or hinder students academically and socially.
Targeting the social networks of group violence
A strong network of friends may be just as big a factor in acts of group violence as having a charismatic leader or a savvy battle plan, according to a new study.
Social networks enable smart household appliances to make better recommendations
In his Ph.D. thesis, David Nuñez, a UPV/EHU computer engineer, has improved the tools for predicting the trust that a user will place in another in his/her social environment and has come up with a new algorithm that selects in less time the minimum set of users of a social network capable of influencing the maximum possible number of users of the network.

Related Social Networks Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".