Abstract: In light of the current coronavirus disease 2019 (COVID-19) pandemic and potential future infectious disease outbreaks, a comprehensive understanding of the negative effects of epidemics and pandemics on healthcare workers’ mental health could inform appropriate support interventions. Thus, we aimed to synthesize and quantify the psychological and psychosomatic symptoms among frontline medical staff. We searched four databases up to March 19, 2020 and additional literature, with daily search alerts set up until October 26, 2020. Studies reporting psychological and/or psychosomatic symptoms of healthcare workers caring for patients with severe acute respiratory syndrome, H1N1, Ebola, Middle East respiratory syndrome, or COVID-19 were eligible for inclusion. Two reviewers independently conducted the search, study selection, quality appraisal, data extraction, and synthesis and involved a third reviewer in case of disagreement. We used random effects modeling to estimate the overall prevalence rates of psychological/psychosomatic symptoms and the I2 statistic. We included 86 studies, re- porting data from 75,991 participants. Frontline staff showed a wide range of symptoms, including concern about transmitting the virus to the family (60.39%, 95% CI 42.53–76.96), perceived stress (56.77%, 95% CI 34.21–77.95), concerns about own health (45.97%, 95% CI 31.08–61.23), sleeping difficulties (39.88%, 95% CI 27.70–52.72), burnout (31.81%, 95% CI 13.32–53.89), symptoms of depression (25.72%, 95% CI 18.34–33.86), symptoms of anxiety (25.36%, 95% CI 17.90– 33.64), symptoms of post-traumatic stress disorder (24.51%, 95% CI 18.16–31.46), mental health issues (23.11%, 95% CI 15.98–31.10), and symptoms of somatization (14.68%, 95% CI 10.67–19.18). We found consistent evidence for the pervasive and profound impact of large-scale outbreaks on the mental health of frontline healthcare workers. As the CO- VID-19 crisis continues to unfold, guaranteeing easy access to support structures for the entire healthcare workforce is vitally important.

Key Words: Severe acute respiratory syndrome, Coronavirus disease 2019, Epidemic, Pandemic, Healthcare providers

Objectives: Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims.

Methods: We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e.g., gray literature, volumes of journals). Two reviewers performed the search, selection process, quality assessment, data extraction, and synthesis. We resolved disagreements by consensus and/or involving a third reviewer. Quantitative studies on the prevalence of psychological and psychosomatic symptoms of second victims were eligible for inclusion. We used random effects modeling to calculate the overall prevalence rates and the I2 statistic.

Results: Of 7210 records retrieved, 98 potentially relevant studies were identified. Full-text evaluation led to a final selection of 18 studies, based on the reports of 11,649 healthcare providers involved in adverse events. The most prevalent symptoms were troubling memories (81%, 95% confidence interval [CI] = 46–95), anxiety/concern (76%, 95%CI = 33–95), anger toward themselves (75%, 95% CI = 59–86), regret/remorse (72%, 95% CI = 62–81), distress (70%, 95% CI = 60–79), fear of future errors (56%, 95% CI = 34–75), embarrassment (52%, 95% CI = 31–72), guilt (51%, 95% CI = 41–62), and sleeping difficulties (35%, 95% CI = 22–51).

Conclusions: Second victims report a high prevalence and wide range of psychological symptoms. More than two-thirds of providers reported troubling memories, anxiety, anger, remorse, and distress. Preventive and therapeutic programs should aim to decrease second victims' emotional distress.

Key Words: human factors, second victim, mental health, adverse event, risk management

Objectives: Despite the critical need to understand the diverse responses by second victims to adverse events, there has not been a meta-analysis examining coping by second victims. We aimed to analyze the coping strategies applied by second victims in the aftermath of adverse events.

Methods: We performed a systematic search of nine electronic databases up to October 2018 and screened additional sources, such as gray databases. Two independent reviewers conducted the search, selection process, quality appraisal, data extraction, and synthesis. In case of dissent, a third reviewer was involved to reach consensus. Quantitative studies of the frequency with which coping strategies were applied by second victims were eligible for inclusion. We calculated the overall frequency of coping strategies and I2 statistic using random effects modeling.

Results: Of 10,705 records retrieved, 111 full-text articles were assessed for eligibility and 14 studies eventually included. The five most frequent coping strategies were Changing work attitude (89%, 95% confidence interval [CI] = 80–94), Following policies and guidelines more accurately and closely (89%, 95% CI = 54–98), Paying more attention to detail (89%, 95% CI = 78–94) (task oriented), Problem-solving/concrete action plan (77%, 95% CI = 59–89) (task oriented), and Criticizing or lecturing oneself (74%, 95% CI = 47–90) (emotion oriented).

Conclusions: Second victims frequently used task- and emotion-oriented coping strategies and, to a lesser degree, avoidance-oriented strategies. To better support second victims and ensure patient safety, coping strategies should be evaluated considering the positive and negative effects on the clinician's personal and professional well-being, relationships with patients, and the quality and safety of healthcare.

Key Words: human factors, second victim, mental health, adverse event, risk management, coping

Background: In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs).

Methods: A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data.

Results: Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions.

Conclusions: Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.

Keywords: Focus group; Mental health; Mixed-method; Patient empowerment; Patient-safety; Psychiatry; Risk assessment; Risk management.

Background Given the automatization of care and rationing of time and staff due to economic imperatives, often resulting in dehumanized care, the concept of ‘humanization of care’ has been increasingly discussed in the scientific literature. However, it is still an indistinct concept, lacking well-defined dimensions and to date no literature review has tried to capture it. Objectives The objectives of this systematic review were to identify the key elements of humanization of care by investigating stakeholders’ (patients, patients’ caregivers, healthcare providers) perspectives and to assess barriers and strategies for its implementation.

Methods We carried out a systematic search of five electronic databases up to December 2017 as well as examining additional sources (e.g., gray literature). Search terms included “humanization/humanisation of care” and “dehumanization/ dehumanisation of care”. We conducted a thematic synthesis of the extracted study findings to identify descriptive themes and produce key elements.

Results Of 1327 records retrieved, 14 full-text articles were included in the review. Three main areas (relational, organiza- tional, structural) and 30 key elements (e.g., relationship bonding, holistic approach, adequate working conditions) emerged. Several barriers to implementation of humanization of care exist in all areas.

Conclusion Our systematic review and synthesis contributes to a deeper understanding of the concept of humanization of care. The proposed key elements are expected to serve as preliminary guidance for healthcare institutions aiming to overcome challenges in various forms and achieve humanized and efficient care. Future studies need to fully examine specific practices of humanized care and test quantitatively their effectiveness by examining psychosocial and health outcomes.

Objectives: In an adverse event investigation, the patients have the poten- tial to add a unique perspective because they can identify contributing factors that providers may miss. However, patients are rarely included in patient safety investigations. We aimed to identify the barriers to patient involvement in patient safety investigations and propose strategies to overcome them.

Methods: We reviewed literature on active participation by patients in safety investigations to construct a framework for healthcare institutions to use in approaching patients about a potential role in investigating an er- ror in their care. We searched 3 electronic databases (PubMed, PSNet, Web of Science) for the years 1990 to 2018, without restrictions to language. Search terms included: “patient empowerment, “patient involvement,” “pa- tient participation,” “patient safety investigation,” “root cause analysis,” “error analysis.” We also examined reference lists of relevant studies to identify additional articles.

Results: Our electronic search produced 10,624 records with 30 poten- tially eligible articles. However, we identified only 6 relevant published ar- ticles. We used these as the basis for a proposed framework that is predicated on the thoughtful disclosure of adverse events and has 3 main levels (i.e., patient, clinician, and institutional level). For each level, we identify barriers to patient participation and potential strategies to overcome them.

Conclusions: The proposed framework can be used as a starting point to promote patient involvement in error investigations. Involving patients in patient safety investigations could increase patient centeredness, patient au- tonomy, and transparency and make analyses more effective by adding unique and potentially actionable information.

Key Words: incident reporting and analysis, patient-centered care, adverse events, patient involvement, patient participation, patient empowerment, transparency

It is a worldwide imperative to prepare the health care work force to deliver safer care. We believe that patient safety should be regarded as a new basic science for health professions education. However, the translation of patient safety science into safe practice is also a highly applied activity. Major reforms will be needed to incorporate patient safety into the curricula of professional schools and training programs. These organizations will need to redirect their focus away from the mere acquisition of knowledge to developing competencies and changing behavior.

The new curriculum will need to include competencies related to providing patient-centered care, working in interdisciplinary teams, using evidence-based practices, and applying quality improvement concepts. These competencies involve changing how students see, and changing attitudes and skills. We would like students to be able to see individual safety problems with system lenses, and be able to identify and test potential solutions. We are aware that there are challenges associated with integrating patient safety into education and training. A major barrier is the prevailing culture of shame, blame, and denial about medical errors. The hidden curriculum competes with attempts to create a culture of safety and allow optimal learning.

Action will be needed from multiple stakeholders in health professions education and health care organizations. Communication from top leaders and transparency throughout the organization are needed in the entire proves. Coordination will also be needed to give students opportunities to practice their new skills in real world settings. We now have sufficient tools for any organization to make a good start. There is still much to learn, such as effective strategies to educate trainees in multidisciplinary and practice-based settings, and how to adapt materials to fit the local context. Innovations are still needed, and building research and evaluation into early efforts will help us arrive more quickly to the goal of making patients safer.