Care for the Caregiver Program Implementation Guide

AHRQ Communication and Optimal Resolution Toolkit

Purpose: To guide an organization in developing and implementing a Care for the Caregiver program.

Who should use this tool? The Care for the Caregiver Program Lead

How to use this tool: Use this guide as a checklist to ensure the needed elements for implementation of a Care for the Caregiver program. There are six sections of activities within the guide, many of which can be addressed simultaneously. By completing the activities in each section, your institution will be prepared to implement a Care for the Caregiver program.

What is a Care for the Caregiver Program?

Support for the caregiver after they are involved in a medical error can be at a local level, an organizational level with trained individuals, or at a referral network level. The tier diagram below represents these different levels of support for the caregiver. Developing and implementing a Care for the Caregiver program at your organization can ensure that these tiers of support are provided to caregivers after they have in been involved in an adverse event.

A pyramid represents the 3 levels of support for the caregiver, from bottom to top. Tier 1 - 'Local' (Unit/Department Support): Department/Unit support from manager, chair, supervisor, fellow team member who provide one-on-one reassurance. Tier 2 - Trained Peer Supporters, Patient Safety and Risk Management Resources: Trained peer supporters and support individuals (such as patient safety officers or risk managers) support mentoring, team debriefing and support through investigation and potential litigation. Tier 3 - Expedited Referral Network: Established Referral Network with Employee Assistance Program, Chaplain, Social Work, Clinical Psychologist, Holistic Nursing Support, ensure availability and expedite access to prompt professional support/guidance.

The six sections within this Guide that address the needed elements for implementation of a Care for the Caregiver program include:

  1. Internal Patient Safety Culture Preparedness.
  2. Identify 'Natural' Second-Victim Supporters.
  3. Establish Team Infrastructure.
  4. Develop Internal Marketing Campaign for Response Team.
  5. Establish Training Program for Second-Victim Supporters.
  6. Ensure Team Effectiveness.

Care for the Caregiver Program Implementation Objectives

  • Identify executive champion(s) and key individuals to help deploy a second-victim support program.
  • Determine the best strategies for clinician support for your institution.
  • Develop an infrastructure to ensure effective support program deployment.
  • Deploy a facility-specific plan to provide interventional support and guidance for clinicians suffering as second-victims.
  • Outline a communication/marketing plan to ensure clinician awareness of available services as well as how to access services.

Each section includes a basic overview of what needs to be accomplished with some leading questions to aid in your planning process.  When applicable, examples and tips for proceeding with action step are provided. For additional support in the planning process, Medically Induced Trauma Support Services (MITSS) resources are available for each of these steps. MITSS provides tools, examples, and policies from other organizations that have developed their own teams. Go to the Clinician Support Toolkit for Healthcare for more.

Internal Safety Culture

Assess your internal patient safety culture to evaluate whether patient safety events are viewed as opportunities to learn about system vulnerabilities and human factors. For example, does your facility review patient safety events openly and share lessons learned? What type of organizational response plan is available for serious patient safety events?

Patient Safety Culture Assessment

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Reporting Culture

  1. Are policies in place to support reporting adverse clinical events?
  2. Does your facility review patient safety events openly and share lessons learned?
YES  NO      
Adverse Event Investigation Process

  1. Is an adverse event policy in place?
  2. What is your reporting culture like?
  3. Do you have an event investigation process clearly outlined?
  4. Do you openly share case findings?
YES  NO      

Care for the Caregiver Team Members

As health care providers, most clinicians have an innate ability to help and nurture others.  Some individuals within your institution(s) perform this function on a daily basis. Identify individuals within your facility to determine who could serve on a steering team to implement a Care for the Caregiver support network within your institution. For example, what internal personnel in my organization could serve as a support for others?

Personnel Resource Assessment

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Key individuals who routinely assist others during times of crisis.

  1. Is a team already in place?
  2. Are individuals already doing this?
  3. Who within our organization has the skill set to support an individual in crisis? Examples of individuals include: social workers, clergy, EAP, Mental Health Workers, HR/Personnel, etc.
YES  NO      
Team Lead

  1. Who is the most appropriate individual to lead the team? Examples might include Chaplains, EAP, Safety/Quality Office, Personnel/HR, Employee Wellness Center, etc.
YES  NO      
Executive Champion(s) for Support Network

  1. Who should be the executive champion? Executive champions might include the CMO, CNO, CQO, HR/Personnel Director, etc.
YES  NO      
Formalized team with roles on the Care for the Caregiver team YES  NO      

Establish Team Infrastructure

The Care for the Caregiver program infrastructure will vary from organization to organization based on personnel resource availability.  Each organization should design a team that is responsive to their local needs and assets. To ensure optimal team performance, it is important to have an infrastructure in place to ensure second-victim supporters are aware of performance expectations.  It is also important for clinicians to know what institutional support they can expect for themselves and their colleagues. For example, who should be represented on our facility’s support team? What mechanism should we implement to ensure prompt referral to professional counseling services when it is indicated?

Team Infrastructure Design

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Business plan for implementation of a support team infrastructure, including operational steps and timelines, budget, and responsible individuals. Seek administrative approval for business plan. YES  NO      
Operational Elements

  1. Method for providing second-victim support to individuals and entire care teams in an immediate time frame.
  2. Activation guidelines for second-victim support for both individual clinicians and entire teams.
  3. Develop policies and procedures for team deployment, intervention andfollowup.
  4. Timeline for team deployment.
  5. Develop a strategy for ensuring second-victim support resources for cases that are problematic or need additional guidance/insights.
YES  NO      
Budget for implementation of a support service.(Consider team composition, on-call expectations, expansion of an existing role, etc.)

  1. How much will it cost to implement a support team?
  2. What are some incidental expenses to support a team?  (pager, training, marketing materials, brochure development, etc.)
YES  NO      
The team structure. Examples of team structures include: trained peers, hired counselors, one responder for all events, EAP, clergy, etc.

  1. What will the team structure look like?
    Who should we recruit for this team?
  2. Ensure “ready access” support for clinicians in high-risk clinical areas and teams.
  3. What are their roles?
YES  NO      

Develop Internal Marketing Campaign for Support Team

Institutional awareness of the second-victim’s needs and interventional support strategies should be readily available to all clinicians. Assess your health care facility for opportunities to showcase information regarding the second-victim phenomenon, as well as identify available interventional support strategies for clinicians in the aftermath of an unanticipated clinical event. For example, how do we spread the word about the second-victim experience? How can we communicate this new program to our clinicians? What marketing strategies should be used to ensure that clinicians are aware of this resource?

Internal Marketing Plan

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Facility-wide second-victim marketingstrategy, partnering with organizational departments such as education and development staff, marketing/PR staff, etc.

  1. What types of activities can occur to inform clinicians of the second-victim phenomenon and supportive interventions at my facility? Examples: Health fairs, employee wellness forums, newsletters, screensavers, etc.
YES  NO      
Identify clinical areas that are at high risk for evoking a second-victim response within your facility, such as ER, ICU, OB, pediatrics, oncology, etc. YES  NO      
Identify high-risk clinical teams that should be monitored closely by supervisory personnel for evidence of second-victim experiences. For example, ambulance crews, helicopter services, Rapid Response Teams, Code Blue Teams, etc. YES  NO      
Establish "real-time" methods for assessing clinicians for second-victim experiences during routine tasks such as team huddles, post activation code de-briefings, shift hand-offs, etc. YES  NO      
Develop an informational brochure on the second-victim phenomenon and your response team. YES  NO      
Identify various facility-wide and department-specific meetings to introduce the concept of second-victim and information regarding your second-victim response team. YES  NO      
Develop "just in time" tools to help clinicians/supervisors contact the second-victim response team. YES  NO      

Establish Training Program for Second-Victim Supporters

Formalize training/education necessary for second-victim supporters throughout your health care facility. Develop an initial training program for second-victim supporters, as well as ongoing educational activities. For example, what should be core elements of an initial training program for second-victim supporters? What type of ongoing education should be available to our second-victim supporters?

Educational Design Strategy

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Identify internal resources for initial second-victim supporter training program. Examples include staff educators, nurse managers, counselors, EAP personnel, paramedics with Critical Incident Stress Management training, etc. YES  NO      
Develop reference tools to be used by members of a support team. For example, team manuals should include information that the second-victim support team needs to complete their tasks.  Minimal information should include: contact numbers for other team members,  information on referrals to professional counseling resources, and checklists for response activations, etc. YES  NO      
Design second-victim support training.  Educate second-victim response team members on 3 main areas:

  1. Second-victim phenomenon.
  2. Providing supportive care following an unanticipated clinical event.
  3. Fast track referral to professional counseling services.

Minimal skills development includes active listening, crucial conversations, stress management techniques, crisis intervention, and indications for professional counseling needs.

YES  NO      
Develop a plan to address ongoing continuing education for members of the second-victim support team. YES  NO      
  1. Develop an ongoing plan to evaluate educational needs of response team members.
YES  NO      

Ensure Team Effectiveness

Implementation of any new program requires evaluation to ensure the program is fulfilling its intent.  Develop a surveillance methodology to determine effectiveness of second-victim support program. For example, is the Care for the Caregiver program supporting caregivers involved in a medical error?

Team Performance Measures

Items Does this exist at your organization?
(Circle one.)
If yes, describe existing items If no, describe Action Plan Person responsible for item or Action Plan
Develop an encounter form to capture general information regarding team activations. YES  NO      
Establish a dashboard overview of general team performance for administrative review and surveillance. YES  NO      
Develop an evaluation tool for second-victims to complete to assess team effectiveness. YES  NO      
Develop a team member satisfaction tool. YES  NO      

Return to CANDOR Contents

Page last reviewed February 2017
Page originally created April 2016
Internet Citation: Care for the Caregiver Program Implementation Guide. Content last reviewed February 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module6-guide.html