How many team members are off sick as a result of your investigation processes?
How willing would team members be to report another incident after being involved in an investigation?
Do teams feel heard in learning responses?
These aren’t easy questions, but they’re pretty helpful to understanding how PSIRF is working for our teams. If we can’t answer them, or if the answers worry us, it’s time to examine whether our approach to patient safety incidents could be making things worse instead of better. The phrase ‘first do no harm’, often attributed to the Hippocratic oath for providing healthcare, equally applies to how we investigate healthcare. Our investigation processes should do no harm. Not forgetting that we have a legal responsibility under the Health and Safety at Work Act 1974 to keep our staff safe and healthy at work.
Can we do PSIRF without supporting staff?
There are four principles in PSIRF. Think of them as four legs on the sturdy chair that our governance system sits on. If one of them is missing or weak, the whole thing starts to become a bit wobbly. These principles aren’t abstract ideals, they came from what wasn’t working in the Serious Incident Framework. They’re the essential balanced components that our governance systems need to have.
Compassionate Engagement: More Than Just Kind Words
Let’s think about how we support staff involved in our investigations, our compassionate engagement and involvement approach in PSIRF. This isn’t about being “nice” during difficult conversations; it’s about having robust, consistent systems that protect staff wellbeing throughout the entire process.
The organisational staff support model from www.secondvictim.co.uk gives us a helpful framework for what this should look like in practice:
1. Preparation: Building Resilience Before Incidents Happen
Do your teams understand what will happen if and when they’re involved in an investigation? Prior knowledge of what to expect can be really protective, like knowing the route before you start a difficult journey. A culture that talks about incidents openly, acknowledges system complexity, and prioritises psychological safety is gold dust here. When staff have already been part of MDT Systems Reviews as observers or contributors to other incidents, they understand the process isn’t about blame. They’ve seen colleagues treated with respect and dignity. They know the focus will be on systems, not individuals.
Organisations can build this preparedness through:
Induction programs that explain PSIRF principles and processes
Regular team discussions about recent learning from incidents
Simulation training that includes debriefing about system factors
Visible leadership modelling curiosity rather than blame when things go wrong
Stories of learning that celebrate insights and improvements
Recognition of excellence that celebrates a well designed system as well as the fantastic individuals working in it
2. Response Post-Incident: Consistency is Everything
Do you have a response mapped out for how you will support staff involved in an incident? Is it consistent across your organisation?
This is where many organisations struggle. Sometimes we have a response that is reliant on existing staff networks and “a good manager”—which means support is patchy, depending on whether someone happens to have an excellent manager or supportive colleagues. We need responses that are consistent across all staff groups (agency as well as full-time, support workers as well as nurses, residents and consultants) and that support all managers to perform as “good managers.”
Consistent post-incident support includes:
Immediate check-ins within 24 hours of the incident
Clear information about what happens next and expected timelines
Practical support such as adjusted rotas or support to work the next shift if wanted
Peer support connections with trained colleagues who’ve been through similar experiences
Regular updates throughout the learning response process
Debriefing sessions for teams affected by traumatic incidents, e.g. using Trauma Risk Management (TRiM) principles
3. Additional Support: Knowing the Route to Specialist Help
In the hopefully rare situation that individuals need additional support beyond immediate pastoral care, do you know how to access this? What arrangements are available in your organisation?
Who is included in your wellbeing offer, for example? Is there a trust psychologist available for staff, and can people self-refer? Are these services equally accessible to all staff groups, including those working nights, bank staff, and support workers? When individuals are able to share their story of being involved in an incident, when supported, this can also be incredibly therapeutic, especially if there is an opportunity for validation from those outside their normal social network.
Organisations need clear pathways to:
Occupational health services with mental health expertise
Counselling or psychological support with self-referral options
Employee assistance programs that are actually accessible and well-publicised
Specialist trauma support for staff involved in particularly distressing incidents
Opportunities to share experiences that are supported and safe
For this insight, I wanted to focus on what we can do outside the learning responses to support staff with PSIRF. In part 2, I’ll share my thoughts on how do we know if our compassionate engagement approach is actually working? We’ll go through some specific evaluation questions you can use with staff involved in learning responses.
As always, hope this is helpful. If you are thinking you’d like to dig a bit deeper into how PSIRF is working in your organisation, or get some thoughts/advice on a particular problem – drop me an email to book in for a no obligation chat.
Thanks,
Lauren Morgan
