Scott Three-tiered Interventional Model for Second Victim Support: Critical Analysis and Scoping Review

In a global context of projected health care workforce shortages by 2030, ensuring workforce well-being has become a priority. The Scott 3-Tiered Interventional Model for Second Victim Support is a widely cited framework for guiding healthcare institutions in supporting staff during challenging clinical events; however, it still presents opportunities for refinement based on implementation experiences.

This study critically analyzed Scott model using Chinn and Kramer reflective critique as a framework. A scoping review was conducted in PubMed, Web of Science, Scopus, ProQuest, and CINAHL, including studies published between 2010 and 2025 in English, Spanish, or Portuguese that explicitly described the model's application.

Eight studies met the inclusion criteria: 5 reported full implementation across all levels of support, while 3 described partial or adapted uses. Implementation occurred exclusively within institutional health care settings and was consistently valued for its practical relevance in supporting professionals after clinically challenging events. Nevertheless, the methodological rigor of the studies was heterogeneous, and several theoretical limitations were identified, including a lack of conceptual precision, absence of operational definitions, and scarcity of measurable indicators. Although originally represented as a hierarchical pyramid, in practice, the levels of support were applied more flexibly and dynamically.

The Scott model remains a valuable theoretical foundation for institutional responses to the second victim phenomenon; however, this article proposes conceptual and structural refinements to enhance its clarity, measurability, and practical utility in promoting a sustained culture of support and safety within healthcare organizations.