Summary

In this blog, Leah Bowden, a patient safety specialist, reflects on the impact her job has on her mental health and family life. She discusses why there needs to be specialised clinical supervision for staff involved in reviewing patient safety incidents and how organisations need to come together to identify ways we can support our patient safety teams.

Content

It was 2am and I found myself on my third trip to my one-year-old son’s bedroom, just to check if he was still breathing. He had a cough and a fever, which we were managing with paracetamol and ibuprofen, but I couldn’t settle. My mind raced with worst-case scenarios—is this sepsis? strep A? pneumonia?

I crept into his room, relieved to find him still breathing. His head felt cooler. I tried to calm myself, texting my husband who was on a night shift. “I’m so worried about Ruairi, I can’t sleep.” He replied, “He’s fine, Leah. His temperature is coming down. You need some rest.” But as I lay in bed, staring at the baby monitor, I knew sleep wouldn’t come.

It was December 2022 and I was leading the Learning From Deaths Agenda for West Midlands Ambulance Service (WMAS). That winter, child mortality rates spiked. What used to be occasional reviews of child deaths turned into several. The Coroner requested photos of the deceased to aid investigations. I found myself opening file after file, seeing photos of dead children. One case hit too close to home—a little boy in the same pyjamas my son wore, cuddling the same Makka Pakka toy.

The room seemed to close in on me. I felt palpitations, tears welling up, and I struggled to breathe. I worked remotely, my husband was at work, so I went downstairs, made tea, and sobbed uncontrollably on my own. I felt ridiculous—this wasn’t my child, my grief, and I wasn’t the paramedic on scene. How could I be so upset?

Before joining the patient safety team, I was a frontline paramedic, witnessing my share of traumatic cases, including child deaths. I moved into patient safety in early 2022 and loved it. But my role shifted from caring for the living to reviewing deaths and I hadn’t realised the toll it took.

My husband, also a paramedic, faces these cases head-on. I felt silly sharing my distress over reviews, thinking I shouldn’t be this affected. So, how do we cope? How do we manage?

Patient safety teams are often small, fostering close relationships. I spoke to my boss daily; she would call checking in with “How are you? The numbers have increased, haven’t they? Are you coping? Do you need anything?” Countless times, I called her in tears, “I’ve just reviewed this awful case.”

But working remotely can be isolating. Reviewing cases at home, especially if you live alone or your partner is at work, can feel very lonely. I’m no longer the Learning From Deaths Lead for WMAS. Now, as patient safety specialist leading the Patient Safety Incident Response Framework (PSIRF), I oversee a team of 11, including 10 learning leads and the learning from deaths lead. Although I no longer review cases of those who died, or who’s care contributed to their death, I now support those who do. I’m the boss at the end of the phone asking, “How are you? How are you coping? Do you need anything?”

One of my learning leads, experienced, who has been in the team years, recently struggled with the impact of her cases. She wants a baby but has seen too many cases where care went wrong and babies died. A situation I had contributed to as I had assigned her these cases because under the Serious Incident Framework we were staffed mostly with alternative duties staff, who were often pregnant, and they couldn’t investigate cases like that. She’s in a better place now, I am thankful to say, but the impact of those cases will stay with her forever.

We need more support for our patient safety teams. These teams show up every day, striving to improve care and make a difference.

We need specialised clinical supervision for those involved in reviewing patient safety incidents. Engagement with families, especially bereaved families, is emotive, heartbreaking and incredibly difficult to do day in and day out. Our organisations need to come together to identify ways we can support our teams and I am excited to be working with Patient Safety Learning to collaborate on what this may look like.

We know the 'second victim' of patient safety incidents is thought to be the staff directly involved in care; is the 'third victim' patient safety staff?

But, for now, I’ll keep being there, asking, “How are you? How are you coping?” I’ll make face-to-face catch-ups mandatory to see them in person. I’ll keep checking my three-year-old is still breathing when he’s unwell, and things he might choke on—grapes, sausage rolls and bouncy balls—will never be allowed in my house.

We would love to hear from you

Do you work in patient safety? How does it affect you? How do you cope with what you see and hear? How do you support your team members?

Please share your experiences and suggestions by commenting below. You will need to be a member of the hub and signed in. It's free and easy to do. 

Further reading on the hub:

• Top picks for staff psychological safety
• “The alarming rate of suicide among healthcare workers should be a wake-up call in the urgent need to support them” (a blog by Claire Goodwin-Fee, CEO of Frontline 19)
• Staff Support Guide - Patient Safety Learning
• Vicarious trauma: The invisible epidemic
• Bitter pill – A paramedic's tale
• How fostering empathy and psychological safety makes healthcare safer: An interview with Carolyn Cleveland

About the Author

Hello, my name is Leah Bowden and I am a paramedic and the Patient Safety Specialist at West Midlands Ambulance Service. I began my journey within Patient Safety in 2022 leading on the Learning From Deaths Agenda before moving into Patient Safety Specialist in 2023 where I led on the transition to the Patient Safety Incident Response Framework (PSIRF). I qualified as a paramedic in 2017, working on an ambulance but also in our Control Room and the Coroner’s Department. I have a particular interest in patient safety culture and improving this for staff and organisations.