Hygiene & infection prevention network

Inge Kristensen on healthcare workers as second victims (Denmark)

June 29, 2021 sani nudge Clinical Advisory Team Season 2 Episode 9
Hygiene & infection prevention network
Inge Kristensen on healthcare workers as second victims (Denmark)
Show Notes Transcript Chapter Markers

On the podcast is Inge Kristensen. Inge is the Chief Executive at the Danish Society for Patient Safety. She is an experienced leader in healthcare and social services, dedicated to quality improvement and patient safety. Inge has extensive experience in leading large-scale projects in hospitals and community care and creating cross-sectoral collaboration focusing on quality improvement. Inge is an experienced moderator, public speaker, and contributor to whitepapers, books, and journals on improvement in healthcare.

A few key takeaways:

On how to approach life

"I get up every morning and think we could do better today than we did yesterday."

On psychological safety and its importance
"You feel secure when you are in your role, in your function in healthcare. It has a lot to do with the ability to have an open and free discussion about errors, about improvement, at your workplace. "

Book recommendations from Inge:
Managing the Unexpected: Resilient Performance in an Age of Uncertainty  

Download  Psychological Safety resources (English / Danish)
Psychological Safety Toolbox


Mon, 7/19 12:59PM • 30:05


organization, psychological safety, patient safety, patients, healthcare workers, healthcare, healthcare sector, hospital, danish, health care, nursing homes, work, program, victims, speak, listeners, errors, impact, mid-Staffordshire, problems


Dr. Marco Bo Hansen, Intro, Inge Kristensen

Intro  00:00

You are listening to the hygiene and infection prevention network. We are dedicated to sharing clinical expertise and hand hygiene resources with healthcare communities worldwide.

Dr. Marco Bo Hansen  00:13

Hi, this is Dr. Marco Hansen, and I'm the medical director at sani nudge. I'm very excited to welcome a special guest to today's podcast. Inge Kristensen is the chief executive at the Danish society for patient safety, is an experienced leader in health care and social services dedicated to quality improvement and patient care. Inga has extensive experience in leading large-scale projects in hospitals and community care and creating cross-sectoral collaboration. Focusing on quality improvement is an experienced moderator, public speaker, and contributor to white papers, books, journals, and healthcare improvement. We are excited to have you in here. Welcome.

Inge Kristensen  00:57

Thank you very much, Marco; it’s a pleasure to be here.

Dr. Marco Bo Hansen  01:00

Inge, we would like the listeners to know you a little more. How would you describe yourself?

Inge Kristensen  01:05

I'm not a healthcare professional by background, but I am deeply in love with healthcare and the healthcare sector. And I have been working in the healthcare sector for Well, 20 plus years, and I would describe myself as very curious, hopefully, also humble; I try to be at least but also very ambitious. I get up every morning and the things that we can do better today than we did yesterday.

Dr. Marco Bo Hansen  01:44

That's a great mindset. And also mentioned in the intro, You are the chief executive at the Danish society for patient safety. Can you explain to us what the Danish society for patient safety is?

Inge Kristensen  01:57

The Danish Society of patient safety is an independent organization working to improve quality and patient safety in the Danish healthcare system. We were founded in 2001 by all the leading stakeholders in Danish healthcare and had been working ever since. And work with improvement programs in healthcare and, hopefully, sometimes to set the agenda for patient safety in Denmark and work very internationally. We have collaborated with the IHI, were a strategic partner with the Institute for Healthcare Improvement IHI in Boston, and work with organizations in the UK and other European countries.

Dr. Marco Bo Hansen  02:55

And what is your main focus at the moment, for some

Inge Kristensen  02:57

time we have been working with diagnostic error. And we think that that's a somewhat overlooked phenomenon in healthcare. And also, we are working a lot with them. What you can say is, well, the old problems in patient safety, we don't seem to have the song. The classic problems are medication errors, infections, and other issues. So that's some of our main focus areas.

Dr. Marco Bo Hansen  03:40

How do you work with the patient safety part? Are you out in the healthcare sector and the hospitals and nursing homes? How do you collect the information and turn it into patient safety?

Inge Kristensen  03:52

Well, we try to harvest ideas. So, we go out internationally to find out what is also working what is working in a Danish setting, and then we try to translate it. As you say, we are working very closely with healthcare professionals and the patients and carers around improving. So, we enjoy our work most when we can be in the field and very close to the problems because our methods are also to create robust pathways and routines to get it right every time for everyone.

Dr. Marco Bo Hansen  04:49

Speaking of work, and also the work you have done in the Danish society for patient safety. When looking into your career track record, you have An impressive Korea already. What do you consider some of the highlights of your career so far?

Inge Kristensen  05:07

Well, some of the highlights have been working with a lot of stakeholders around infection control, creating a program for infection control in the capital region of Denmark and, well, nationally. But I'm also very proud of some of the cross-sectoral work I've been doing to find new solutions for some of the work between hospitals and the primary sector.

Dr. Marco Bo Hansen  05:43

That sounds very interesting. And another important topic that I know you're working with that I'm very interested to hear more about is psychological safety. Can you tell the listeners what psychological safety is and why it is so important in all the work you're doing? And in patient safety?

Inge Kristensen  06:02

Yeah, I wouldn't mention it because I knew you would ask about it. So but, but some of the work we're doing around psychological safety is very dear to me. And very important, I think for the healthcare sector in the future. Psychological safety is a paradigm you could say what it's developed. Mainly our has come on the agenda by the work of Professor Amy Edmondson, Harvard professor, what it is about is that you feel secure when you are in your role in your function in health care. So it's, it's really about the work environment. And also has a lot to do with the ability to have an open and free discussion about errors about improvement at your workplace.

Dr. Marco Bo Hansen  07:07

And what in your mind, what do you think happened? If an organization doesn't have the level of psychological safety needed? What are the consequences,

Inge Kristensen  07:18

More and more research shows that the lack of psychological safety can lead to patient safety incidents, where patients are harmed. And also, it has been very clear and obvious, I think, during the COVID era, that a while lacking psychological safety has led to that healthcare professionals go out of the work. They leave healthcare, get depressed, a burnout, all kinds of negative implications of psychological safety, and negative implications for the safety of the patients.

Dr. Marco Bo Hansen  08:12

And if you are listening to this podcast now and you are a healthcare worker or a manager leader, thinking, does my organization have the right level of psychological safety? How would you How would you know?

Inge Kristensen  08:29

Well, there are more and more tools you can use for the assessment of psychological safety. You can work systematically with the website, psychological safety, more and more. And do we have together with the organization called the Copenhagen Academy for medical simulation, developed some tools that we are using in the healthcare sector in Denmark. Still, I know there are more and more, for instance, Cincinnati Children's Hospital, I would say, well leading in some of this work, and it's amazing to see how they work with the speed of culture. And that the impact on the safety incidents has been very clear.

Dr. Marco Bo Hansen  09:29

Can you perhaps come up with an example of an organization where psychological safety was lacking and what the consequences of these were,

Inge Kristensen  09:40

I can propose or find an example by where it had a serious impact, and that's around. We had some cases around young boys with meningitis who died, and at least in one of these cases, we saw That a nurse tried to speak up. It was difficult for her, and she wasn't listening to in the concrete situation. And eventually, the young boy died. And of course, it was not that thing in itself that led to these avoidable deaths, but it certainly had an impact.

Dr. Marco Bo Hansen  10:29

Yeah, and these are, of course, tragic events, and we must do everything we can to prevent these events in the future and learn from the events. And some of the things that I've also seen in the healthcare culture are the fear of making mistakes, making errors, and these fears can be so intense that you are afraid to talk about errors in the first place. Is that something you're also working within in your organization?

Inge Kristensen  10:58

Yes, we work; we have quite a large program around mental health for healthcare professionals. And, it has evolved around the notion about a second victim. So the patient, of course, is the first victim of a serious adverse event. But on the back of that, the second victims and we all know that the healthcare professionals are in grave danger, for depressions, developing depressions, and even suicide. So. So it is very important that, that as a part of psychological safety, we have an environment where it is legitimate to talk about errors, and where there is a support system if errors occur and that no, not if when they occur, because they do whether there are people that there will be made mistakes. So So that's, that's obvious, and there should be a systematic approach to that. So we're developing that right now together.

Dr. Marco Bo Hansen  12:22

with a hospital. And these second victims, that's, that's one of the new, you can say, definitions that probably many of the listeners haven't heard before, have understood it correctly, to say that patients are first victims, healthcare workers, can be the second victims if we don't have a culture to embrace them and ensure that they don't get mentally distressed.

Inge Kristensen  12:48

Exactly. And actually, we also talk about third victims because the whole organization can be affected by a series of events. And, over time, their psychological safety and environment can suffer from these incidents. So if they, if they're not dealt with timely, it will show.

Dr. Marco Bo Hansen  13:16

overtime that is so interesting. I've learned something new first, second, and third victims; it’s important to know these things and deal with it. Okay, so I want to shift focus a little bit too patient perspectives in nursing homes. And in 2020, your opinion was featured in a chronicle in a Danish news newspaper, and it is a respected Danish opinion piece for our listeners. So you shared that in nursing homes and healthcare organizations, the five most dangerous words are it could not having here. So can you please explain to us what does it mean? It could not happen here, and why is it so dangerous to say this sentence as an organization?

Inge Kristensen  14:05

Well, using those five words, I think they are? Well, intuitive. Sometimes. I think that when you hear that something dreadful is happening, you would say, well, it couldn't happen to us. It couldn't happen here. We have an organization with which is solid and where these events couldn't take place. But you have to pause, and you have to reflect. Because while most things can happen to anyone, and they and that's not well, that's not the problem is not to face it and find out how we can avoid these events? And how can we ensure that we are proactive in our ways to ensure that we have a safe system for our patients? So, for the citizens and also for the healthcare.

Dr. Marco Bo Hansen  15:22

workers, it is especially timely considering the tragedy that unfolded in nursing homes due to the COVID-19 Is it a particular phenomenon we see in nursing homes, the phrase it could not have been here, or do we also see it other places in society,

Inge Kristensen  15:40

the Chronicle built on the scandal, the Mid Staffordshire scandal in the UK. And I was trying to point out some of the learning issues, the learning point from that scandal, and that was the hospital where it looked from the outside as if they were, you could see in green. So you couldn't save from any of the control mechanisms so that there was anything wrong, but it was clear, when they looked into data in new ways, they could see that there were more or the mortality was sky-high. And the patient's stories and the carrier stories that surfaced were so grave that you can't find Mid Staffordshire on the map today because they shut that place down. So so it happens, it can happen everywhere. And in a way, I've had some cases in nursing homes these recent years. And when I look back and see media stories, we can find them from time to time. They surface so that it can happen in every sector. And usually, it happens, where there are a lot of patients, so on citizens who are witless, not able to, to take care of themselves.

Dr. Marco Bo Hansen  17:35

And how to work with this mindset as an organization. Any comments on that?

Inge Kristensen  17:42

It is a cultural phenomenon. And you have to work consistently with the culture. And you have to do that every day. You have to be proactive and have to set out some guidelines for how you want to work in our institution, workplace hospital, whatever unit you are in, and go for that relentlessly. And always have high standards. I also think that we need to talk more about ethics. There are in some hospitals and, and hospital organizations and also other types of welfare organizations. There are a wealth of ethical committers. But I don't think it's an I don't think it's it's common. You can find it, but it's not common. I believe we need to talk a lot more about these things regularly. Because if we adjust Well if you just adjust to things, they will deteriorate over time.

Dr. Marco Bo Hansen  19:15

Yeah. And that's a really important point that even though you might organize ethical or ethics bodies and talk about it in the management wards, it might not go down to all the others who work in an organization, others and they might not embrace it. So it's how you put it. You get it in the culture. That's the difficult part, I think.

Inge Kristensen  19:41

Yeah, and, and every journey begins with the first step. So so you have to be very specific. And if you pass by something you accepted, so it's, it's day-to-day work.

Dr. Marco Bo Hansen  20:00

Yeah. And that's, that's a really good point, I know that. The thing about if, if you pass something, you see something, you can speak up. I remember, not that long time ago, I was visiting my granddad in the hospital. And I could see, one of the doctors was wearing a watch on the wrist. And you are not allowed to do that for hygiene purposes. But I didn't dare to speak up because I was afraid that it would impact the treatment of my granddad. So why do you think you think that is? That we don't speak up? And don't they add to say something if we see something's wrong?

Inge Kristensen  20:49

Yes, but that that's about your psychological safety. I don't know about you, but what I have experienced is going into a hospital. I can feel or a nursing home, and I can feel immediately how things are; I can think that this is a good place. People say hello to me. Greet me, they, it seems there's an open culture there. There's, it's, it's nice, you can feel it. And sometimes you also go into places, and you say, I don't feel comfortable here. I'm not sure where things are. No one says hello to me. They just have this, you know, this eyesight where they are just not looking to the sides when they walk down the hallway. So whatever you experience, and then and that, of course, imposes. Subconsciously imposes a feeling in us and our ability to speak up. And I think that we should all be able to speak up because one of the most important sources of information for treatment and the well-being of patients is the patient itself or other relatives. So so you have to listen. And I think it's part of the well, the ethical conversation, and the psychological safety that you see some of these comments as a gift. And I see it in other industries. They use complaints very systematically and see them as a gift to the organization on how to improve, should try to impose on the health care workers said it's a gift.

Dr. Marco Bo Hansen  23:07

And I guess you can also start from today talking about psychological safety and just be aware of it wherever you go. Because in the supermarkets, when you see people not sanitizing hands, you most often don't say anything because you also think that you don't want to be rude to them, or you're afraid of them, seeing it as an accusation or something. So I guess society also likes a bit of psychological safety, you can say.

Inge Kristensen  23:40

Absolutely. And perhaps there is a little crack now from the COVID situation that we can take on that, that it's more legitimate to speak up also in Well, the supermarket or wherever you are.

Dr. Marco Bo Hansen  24:06

Exactly, exactly. And speaking of the corona pandemic, I really would like to talk about the impact of the pandemic on healthcare workers’ mental health and patient safety. You briefly touched upon it, but what are your thoughts and insights into the impact of the corona pandemics on healthcare workers’ mental health and impact on patient safety?

Inge Kristensen  24:31

I think that some of the issues that have come up, we knew that already but the corona period has been a pandemic has been like a giant light shining on health care to see all the cracks. You can see where some of the problems are, and I think For, for healthcare workers, psychological safety has become much more legitimate to talk about psychological safety. And I think the link between psychological safety and patient safety has become much more apparent. And we can use that forward. So that is one of the things, I also think that equity is for patients is one of the issues that the that we have got some, well, you could say negative insight on in Denmark, we have experienced that, that we have made a lot of systems and done it very quickly. But the well, the vaccination programs where you get an email or an electronic message, well, maybe 20% of the population cannot either receive it, read it, or respond adequately on it. So the system itself, is this making some of these errors, you could say, and we should learn from that because we see very clearly during the corona pandemic, but it happens all the time.

Dr. Marco Bo Hansen  26:34

I completely agree. And do you think we will? Will? Will we see more of it moving forward if we don't do anything about it? And how can we do something about it? What are you What's your take on this?

Inge Kristensen  26:47

Well, we have to go back to your very good example about the wristwatch and not say anything about it; we have to listen very carefully to what the patients tell us. And the relatives tell us because some of the insights we need to improve health care come from the relatives and the patients.

Dr. Marco Bo Hansen  27:20

And I agree, we are not good at that. This mutual awareness and mutual communication between patients and relatives and healthcare workers lack many healthcare organizations. So that is, of course, an important focus area. A for all of the podcast guests, I'm always asking for expert insight, whether you have a book or an article, Chronicle or something that you have just stumbled upon, that you find very interesting and that you think others should perhaps read or listen to, is there anything that you can recommend to our listeners?

Inge Kristensen  28:04

Oh, I think there's so much interesting going on out there and beyond. Well, diving deeper into psychological safety, I would certainly recommend that you read if you haven't done that already. the book by Karl Weick and Catherine Sutcliffe, which is calling, managing the unexpected. Because it's a very comprehensive work on building a resilient organization, and how you can be proactive and endure some of these well, shortcomings or situations where there is a crisis, and even some of the day-to-day problems around staffing and things like that, so, so that's a very good book.

Dr. Marco Bo Hansen  29:08

Awesome. This is well noted. Thank you. So our audience includes hygiene preventionists, healthcare workers, researchers, and leaders across the healthcare space. Do you have a tip for those seeking to make a difference in health care?

Inge Kristensen  29:25

Ask yourself, what can I do by next Tuesday, or even by tomorrow? Because there's always something you can change and, and well, as I said, every journey begins with the first step. So I would recommend that certainly,

Dr. Marco Bo Hansen  29:47

that's great advice. And this is well notice, and Inga, thank you for your time and for sharing your thoughts and insights, and thank you to our listeners. Be safe,, and remember to clean your hands.

About Inge
Creating national strategies for infection control
Psychological safety
Consequences, the 2nd and 3rd victims in healthcare
Patient perspectives
Expert recommendations