Learning from critical incidents

The pandemic had a major impact on the mental health and wellbeing of practitioners and this may persevere for some time. But while pandemics are rare, critical incidents are not uncommon in health and social care organisations and they can have serious implications for practitioners’ wellbeing and practice. However good we are at managing and learning from critical incidents, a crisis can sometimes send shock waves through an organisation. This can lead to a ‘perfect storm’: a combination of events or circumstances that has the potential to bring adversity to an organisation.

If not managed effectively, such situations can cause widespread damage – to individuals, the organisation and the sector as a whole.

An organisation’s initial response to shock may be paralysis or panic, neither of which is helpful. Nor will such responses help people working directly with patients or families to continue in their work.

Leaders should be aware that, like any personally upsetting event, an organisation’s reaction to a critical incident may be one, or all, of the following:

• Shock
• Fear
• Anger
• Shame and guilt
• A sense of injustice

Initially, communicating the news clearly internally and externally and making space for managing the crisis is crucial. Mellor identifies three stages for managing a major event (more information can be found here):

• Response
• Resolution
• Recovery

Organisations that disregard the impact of a difficult or traumatic event and try to carry on as normal are often working on an adrenaline-fuelled stress response, instead of considering the need for an alternative approach or re-grouping. Organisations should have mechanisms in place to help them recognise what has happened, how to respond, how to resolve the issue, and how to ensure there is space for recovery. 

Treisman (2018) provides useful guidance and practical tips on helping organisations become more ‘culturally, adversity and trauma-informed’, and warns against the risks of tokenistic initiatives to promote trauma-informed and responsive practice; for more information, see here.

Guidance on how to recognise and manage secondary trauma among practitioners is also available here.

Emotionally literate leadership is crucial for a considered and effective response to a shock or crisis, so leaders must be able to recognise and manage their own emotions. There are several useful frameworks that can help leaders process and articulate their feelings. 

For example, the following questions derived from Linsley & Horner, 2011) are likely to be a useful starting point for planning a response to a crisis:

• Here is what we are facing (assessment)

• Here is what I think we should do (option appraisal)

• Here is why (evidence base).

Critical incident analysis is a structured form of learning and reflection, It involves:

• Describing a difficult or serious incident that was particularly challenging

• Suggesting an explanation, given the immediate context.

• Asking questions to find different explanations for the dilemma, exploring theories, values, assumptions and defensive mechanisms and biases.

• Considering the implication for future practice.

 (adapted from Tripp, 2011)