Embedding compassion: organisational culture and leadership in caregiver support after medical error

Preventing patient harm is a core ethical responsibility in healthcare. While support for patients and families after adverse events has improved, formal support for clinicians involved in serious medical errors, referred to in the USA as 'caregivers' remains inconsistent. This study reports the qualitative findings from a mixed-methods US study exploring healthcare leaders' perspectives on medical errors and caregiver support. The quantitative phase (n=81) found that only 64% of organisations had a caregiver-support programme and over one-third of leaders could not confirm such support existed. These results informed 19 in-depth interviews analysed thematically to identify perceived barriers and enablers to support.

Healthcare leaders who participated in the quantitative phase were recruited for semistructured interviews. Transcripts were coded independently by multiple researchers and synthesised through iterative consensus using thematic analysis.

Five themes emerged: (1) impact of leadership, (2) embedded in the culture, (3) supportive response, (4) utilisation of existing infrastructure and (5) self-imposed barriers. Leadership engagement, organisational culture and stigma were central in shaping caregiver recovery after medical error.

Findings highlight the need for a 'compassionate just culture', defined here as an organisational approach that integrates accountability, empathy and restorative practices to support all parties after harm events. Quantitative and qualitative insights underscore the urgent need for trauma-responsive, co-designed caregiver support systems that address both individual and structural contributors to distress. Healthcare leaders play a pivotal role in ensuring compassionate, non-punitive support following medical errors. Strengthening these systems can enhance workforce well-being, organisational trust and patient safety.