AAOS Now

Published 7/1/2012
|
Linda K. Kenney, with Winifred N. Tobin

New Tool Kit Helps Build Clinician Support Programs

Addresses the many levels of healing necessary after adverse events

When things go wrong in health care, patients and their families aren’t the only ones who suffer. In 1999, after I (Linda Kenny) experienced a near-fatal adverse event, the caregivers involved in my case—anesthesiologist, code team, and orthopaedic surgeon—openly shared with me the pain and devastation they were experiencing. At that time, support systems for patients, families, and clinicians were practically nonexistent.

As a result, when I founded Medically Induced Trauma Support Services (MITSS) in 2002, an organization whose mission is to support healing and restore hope to those involved in medical errors and adverse events, I knew that support for clinicians would have to be a cornerstone of our activities.

Since then, I have spoken to hundreds of groups across the country and around the globe, spreading the MITSS message of hope and healing. I have been inspired by the courage of clinicians who have spoken up about their experiences. They relate personal stories about events—some of them recent, but often from a decade or two ago—that continue to haunt them daily.

Over the last 10 years, an important trend has emerged. In the early days of MITSS, raising awareness and educating about the need for clinician support was well received, but few organizations were invested in creating the systems and infrastructures, let alone effecting the cultural changes, necessary to implement a formal clinician support program. In recent years, however, successful programs have sprung up, and other organizations are now eager to begin the process. Notable examples are the ForYOU Team at the University of Missouri Health System led by Sue Scott, RN, MSN, and the Center for Professionalism and Peer Support at Brigham and Women’s Hospital led by Jo Shapiro, MD. (See “Peer Support When We Need It Most.”

Thus, for MITSS, “Keep up the good work. You’re doing a great job,” has given way to “How can we do it? What do we need to start our own program?” In response to this spike in interest and apparent organizational and industry readiness, MITSS developed the “Clinician Support Tool Kit for Healthcare.”

Website and tool kit
Seeking a wide range of opinion and depth of knowledge, we empanelled a blue-ribbon advisory group—clinicians, patient advocates, hospital leaders, and published experts. All had expertise in the emotional impact of adverse events on clinicians and experience in developing emotional or institutional support processes. This group convened in early 2010 and held meetings via conference calls, sharing materials and resources between calls. All decisions regarding the tool kit were made by consensus.

Initially, a number of basic decisions were made. The group envisioned that organizations would be able to use the tool kit regardless of where they were on the spectrum, anywhere from the information gathering phase to those with programs up and running. Therefore, they decided to make the tool kit modular so that organizations could use a few of the modules or the entire tool kit. They also decided to include specific action steps to ensure a successful program. Everything in the tool kit would be referenced, ensuring that the most up-to-date evidence and documented best practices were included.

The group then identified the components or the core elements of the tool kit, resulting in the following list:

  • internal culture of safety
  • organizational awareness
  • formation of a multi-disciplinary advisory committee
  • leadership buy-in
  • risk management considerations
  • policies, procedures, and practices
  • operational
  • training of staff supporters
  • dissemination/communication plan
  • learning and improvement opportunities

Each core element includes links to articles, videos, survey tools, forms, and relevant bibliographies. An organizational assessment tool, designed to evaluate institutional readiness for the development of a clinician support process, is also included. The MITSS Tools website (www.mitsstools.org) went live in December 2010.

The website contains tools, information, and resources for patients, clinicians, and healthcare organizations on a wide range of topics ranging from self-care after an adverse event, common reactions to trauma, and how organizations can support patients and families following adverse events. The Clinician Support Tool Kit can be found in the “For Clinicians” section under Tools for Building a Clinician and Staff Support Program.

As an evolving body of work, the tool kit will continually incorporate the most timely resources available and lessons learned. Additionally, the authors hope to gather data from users on its utility and their experiences with implementing a clinician support program.

A positive response
By all accounts, reception to the tool kit has been overwhelmingly positive. Traffic to the website has been brisk, and more than 850 organizations have provided their contact information to download the kit in its entirety. Additionally, the MITSS held an educational forum, Implementation of Clinician Support Programs Following Adverse Events, in November 2011. More than 100 people participated in the forum, which also featured presentations from nationally renowned clinician support experts.

Currently, MITSS’s goal is to continue to disseminate the tool kit and gather feedback from those using it. This process will enable us to continually update the content to maintain its currency and relevance. Ultimately, we hope that clinician support mechanisms will be built into hospital and healthcare system infrastructures so that they can be routinely and easily accessed.

Linda K. Kenney is the founder, president, and executive director of MITSS; Winifred N. Tobin is the MITSS’ communications director. For more information about MITSS, visit www.mitss.org