[MUSIC] In this presentation, we're going to talk about how peer support makes a difference for second victims. We know that things don't always go as planned in healthcare. And anecdotal reports and published literature tell us that peer support is crucial when things go wrong. A good definition of peer support is by Survivor Corps, and is encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self confidence and autonomy and to enable the survivor to make his or her own decisions and implement them. So where do you get peer support? Well, most people would say from their friends, their family, their mentors, their coworkers, or managers, and supervisors. Are these people typically trained to provide peer support? Oftentimes, we hear they're not. And that can make all the difference as to whether the support provided is helpful to the second victim or is actually more harmful. In Johns Hopkins Hospital we developed a peer support program called Rise, Resilience in Stressful Events. Our program is a confidential, non-judgmental, safe peer-support program for employees who have experienced stressful patient-related events. Not just for the second victim but for those who feel like a second victim and can describe feelings of stress related to patient-related events. We summarize our support as psychological first aid and emotional support. In our five years of experience in providing support to many of our caregivers across Johns Hopkins Hospital, we've discovered that there's seven key principles to providing peer support successfully. The first one is show up. Be present. Be fully engaged with no distractions. The second one is stay calm. Provide a non-anxious, non-judgmental presence. And the third is really important, and that's to listen. And that means that the peer responder is not doing most of the talking, but the person who called for support is. The fourth is to empathize. And really helping the employee understand that you can relate to what it is that they've experienced. And how hard it must be or how difficult it must be to be going through that experience. As healthcare workers, we know that we like to fix things. And sometimes, trying to fix the problem is a challenge. And when providing peer support, it's a key ingredient to avoid fixing and really focus on the first four principles of peer support. Maintain confidentiality, and you may need to partner with your risk management or legal team on this. The only time that a peer responder should break confidentiality is if an employee indicates harm to self or others. And then activate a debrief. The peer responder needs support too. And so, having a debrief that de-identifies any information and focuses on how the responder felt the encounter went is key. A few things that make peer support unique to other resources are that it's timely. A responder shows up by phone or in person within 30 minutes. The support is available 24 hours a day or 7 days a week. Support can be provided one to one or in a group. The peer support or peer responder team, known as RISE, is a voluntary team of caregivers across Johns Hopkins hospital, multidisciplines, who have applied to be a part of the team and have had support through their organizational leaders to say that they would be a good person for the job. These people are trained, and they commit their time on a voluntary basis to respond to people in need. As we talked about in the previous presentation, the stages of recovery, stage 5, obtaining emotional first aid. And now we know what that means, has a great impact on stage 6, which is moving on. We have several stories as to how the psychological first aid and emotional support impacted a caregiver's ability to move on. One story is about a critical care nurse who was involved in a medication error. She was the second check for an infusion that was running entirely too fast, and as a result the patient suffered harm and had an increased length of stay in an ICU setting. This expert nurse had been a caregiver for more than 20 years and was devastated. This expert nurse thought that she was going to quit her profession. She decided that it was time to throw in the towel. After meeting with Rise, she was somewhat hopeful. And what we found out was seven months later, this nurse was thriving. Thriving is the goal. Getting our people back into the resilient zone so they continue working in their role and in their profession. We've talked about, in the previous presentation, other choices that caregivers make. One is drop out, and such drastic cases as suicide is one example. But leaving the profession or leaving your organization are other examples of drop out. Another path to choose in moving on is surviving. Based on a survey that we conducted at Johns Hopkins Hospital, we found out that most of our caregivers are merely surviving. And that means that they show up for work. They get the job done. That they are possibly plagued by an event and could be somewhat disengaged. Another story about a nurse that decided to move and thrive was a colleague of mine by the name of Michelle. Michelle was a nurse taking care of Josie King back in 2001. Michelle decided to meet with the Rise team when we were implementing the program in 2011. It was the first time that Michelle had an opportunity to share her story and receive support from peers. One year later Michelle called me to tell me that her heart felt like a 10,000 pound weight had been lifted. And that she was feeling better than she had felt in the last ten years of her life and that she was forever grateful for the peer support that she received from the team. Michelle is now thriving in her job. And fortunately, she's still here at John Hopkins Hospital. There's also a cost-benefit that goes with peer support. We conducted a study of the RISE team support here at Johns Hopkins Hospital. 36 nurses participated, and we used data from human resources and from the Rise program to conduct the study. We discovered that even though Rise costs money upfront, the cost associated with the risk of losing a nurse or a nurse taking time off after event was greater. The potential cost-benefit yielded a positive net monetary benefit of $22,576 per call if RISE was used. Peer support can have a significant impact on the individual, the team, and the organization, reversing the cycle that we saw in the previous presentation.