Why this study

All existing intervention programs with second victims (North American, British, Australian, and the aforementioned Spanish ones) are activated when an adverse event (AE) occurs and, therefore, work directly with second victims. Interventions for preparing hospital professionals for this eventuality hardly exist.

In the USA, we have found some institutional-level intervention guides and checklist examples, such as that from the General Hospital of Massachusetts. The forYOU program at the University of Missouri hospital implemented a program for training professionals to support their second-victim colleagues. Hospitals at the University of Washington have developed applications (pocket tools) to assist professionals to engage in frank communication with patient victims of an AE. The Boston group is developing informational packets and activities to raise awareness in professionals at Harvard hospitals who might become second victims.

These programs and the approaches rolled out as of today have only been focused on hospitals. Thus far, no actions with second victims have been developed in primary care (PC). Furthermore, there are no guides or tools in Spain (or in hardly any surrounding countries) for preventing the impact from AE in professionals that we know occur in at least 1% of primary care consultations and with 10% of patients who are hospitalized. Although most AE have slight consequences, in many cases they do affect the clinical judgment of the professional during at least the subsequent days, so in addition to the emotional effects, the risk of additional AE increases.

This coordinated project will jointly address in a comprehensive manner the problem of second victims in Spain and it will make intervention schemes and tools available from its National Health System to reduce the impact of AE in health professionals. As for general objectives, this project will strive to learn about the magnitude of the problems of second victims in Spain in primary care as well as in hospitals in personal and professional terms alike, offer intervention guides to managers and those responsible for patient safety, reduce the negative consequences in health professionals (second victims) from AE that result in moderate or severe consequences in one or more patients, foster a pro-active culture of safety in primary care and at hospitals, and promote ethical behavior with patient victims of an AE.


  • There are no data in Spain that permits delimitating the magnitude of the impact of AE in professionals, second victims, or the direct costs for health institutions.
  • We do not know how health institutions are addressing support measures for second victims or the extent that, in either PC or at hospitals, protocols for fostering frank communication with victims of adverse events have been promoted that also contribute by helping second victims cope with the professional consequences from AEs.
  • Today’s intervention programs with second victims are activated when an AE actually occurs, and therefore work directed with the second victims. There are no interventions for preparing professionals for this eventuality.
  • So far, no actions of any kind have been developed with second victims in primary care.
  • There are no guides or tools in Spain (nor in hardly any surrounding countries) for reducing the impact from AE on professionals. 



  • Evaluate the magnitude of the impact (on personal, professional, and economic levels) that adverse events suffered by patients have on health professionals (second victims) and their institutions.
  • Produce two intervention guides for managers and those responsible for areas of patient safety in PC and at hospitals; along with virtual tools to help professionals from both care levels reduce the impact from AE in healthcare professionals (on personal, family, and professional levels), to strengthen the culture of safety at institutions, and encourage ethical behavior with patients (open communication with patients who suffer AE).