Table 2 Common Domains with their Themes from Interviews with Experts

Recognition by Quality and Risk Departments of need for support for healthcare providers

“We were a little worried that we were talking to the people who were involved in RCA, but these weren’t normal events…It was pretty noticeable that we weren’t getting it that everyone may need help or may be struggling.” D page 4.

“And in my role at ***, you know, I oversee all the investigations of all the serious adverse events and the RCAs and just the really bad cases, and I saw the impact it has on providers.” I page 3.

Sequelae of being a second victim are significant

“I mean, they are literally telling you that’s it, ‘I’m quitting’ medicine, I’m quitting surgery, I’m quitting, you know, whatever just because of a bad incident that shook them up so bad.” C page 8.

Emotional consequences when providing complex patient care are substantial

“She felt at times she was helping the team cope with what was going on as much as the patients and families in the PICU.” H page 4.

“I had interviewed from EVS staff who worked in the trauma bay and who were quite disturbed when they walked into OR to clean and they were standing in puddles of blood and just felt helpless, you know, like, what had happened here? How am I going to get through this? How am I going to clean this up? How am I going to get through this emotionally?” D page 5.

Limitation of resources impacts the success of SVPs

“It wasn’t a part of my role. I have made it a part of my role, but I have a full time job besides this, so I can’t give it the type of dedication and effort I would like to because I am kind of squeezing it in on my own time...There is no monetary resources for that…it has been something that we do because we think it’s the right thing to do.” B page 7.

“Now, I say in ‘real time’ because there are two of them right now and depending on how we fund the program moving forward, it may change a little bit. But essentially you know, if they get called in the middle of the night, the idea is, like, do they call back right at that moment? No, they usually call back, like, seven o’clock the next morning.” H page 3.

Lack of program awareness and leadership buy-in, impacts SVP success

“So, the people that used it, overwhelmingly thought it was effective and it helped them. But the number was small because – the number of people using it was small because of a lack of awareness.” I page 11.

“The challenges are buy-in from some departments, physician departments and the GM program directors… They have a wellness survey and we tried to incorporate questions as part of their wellness survey. And in the end, we got thrown out.” D page 7.

“Continuing to educate both the administration about the importance of the program and continuing to receive support.” F page 10.

Concern for legal action, confidentiality, and stigma influence physician participation in SVP

“They worry that someone is going to find out I had a conversation with this clinician and what if this turns into a legal action and I get subpoenaed?” B page 9.

“Again the priority is confidentiality, so we can’t go back and ask people involved and so, we discussed it a lot but then decided that confidentiality takes precedence.” G page 7.

“It is trying to change the culture of like, suffering in silence.” F page 8.

“Well, I think it’s two things: one, people actually knowing about it and, two, so that getting rid of the stigma about reaching out for help.” I page 4.

Lack of systematic tracking effects on sustainability

“It’s kind of for them a chicken and an egg situation: they need more funding, but they don’t have any data to kind of back up the work they are doing so it’s a tricky situation.” A page 7.

Increase recognition of SVPs noted at the institution

“It’s Swartz Rounds, and somebody said, well, was the *** team called? And that was, to me, a measurement of success that somebody was able to say, oh, we have this resource at our hospital and were they called for this adverse event. So, acknowledgement of the program, and they know it’s a resource, they know it’s available.” F page 9.

Learners are interested in second victim support

“They have ramped up direct access to our provider assistance services through after hours support by working with our provider assistance services and creating dedicated target spots just for GME.” H page 10.

SVP success results in expansion within the healthcare system

“I would say the biggest system change that I have seen is just different clinical areas that didn’t use to ask for help are now asking for help, and one of those examples would be like the emergency department staff.” F page 10.

“It’s really expanded because it’s expanded more into different hospitals in the *** system.” F page 9.

Increase of buy-in by leadership

“We heard a lot of comments around how appreciated the organizational commitment was to putting this program in place, which I think is part of the reason our hospital president this year is like, come on, we have to figure out a way to absolutely keep this going this year.” H page 8.

“We got some new leadership and I think, in my mind, some pretty forward-thinking people really interested in, you know, safety and quality and just culture…I had a new CMO and a new deputy CMP that were really champions for this…” I page 3.

Systematic changes as a result of SVP success

“We are retaining more staff members, when people are being more vocal about what they are going through and asking for help.” F page 9.

“So, for example, if we see like a serious harm event we review as part of those analyses in the event investigation, whether the team needs help and should we deploy those resources to go out and help that team? And we have embedded this all in a policy.” H page 3.

Increase awareness of SVPs via different educational resources

“She continues to give brochures out, to update the brochures. They continue to do the training for staff members. They continue to spread the news, kind of word of mouth. So, there has been a lot of publicity the last couple years, and so it is moving along.” F page 10.

“I talk about that in orientation with the residents so that they expect it, so it doesn’t feel like people are singling them out. They know that they are going to get contacted if I see a difficult case.” B page 6.

Structuring the program in ways that enhance provider interest in seeking support

“Physician colleagues talking to physician colleagues. So, rather than having somebody that may be a, you known counselor or psychologist talking to another physician, the thought was when they developed the program was physicians talking to physicians to support them through whatever may have happened.” C page 2.

Establish processes to measure SVP impact

“We also did a baseline survey before we launched the peer support program, we did a grand rounds presentation about what peer support was and then, we did a survey asking about what has your experience been with difficult cases and adverse events and what helps you? And then, we resurveyed 3 years later to see how people’s perceptions had changed and what was different to try and figure out, were people comfortable adopting this, and, yeah, people seemed to really like the resource.” B page 6.

“We added 2 questions to our culture of safety surveys, and it was: have you experienced a traumatic event within the last 12 months… What it showed was that people who have an event and were provided support scored higher that those who never had an event and extremely significant increase compared to those who hadn’t received support.” D page 6.