A patient safety incident is any unplanned or unintended event or circumstance which could have resulted, or did result, in harm to a patient. Patients, their family members and health care staff report that their expectations for care and information following a patient safety incident have not always been met.
Open disclosure is a process for ensuring that open, honest, empathic and timely discussions occur between patients (and/or their support person) and health care staff after a patient safety incident.
Effective open disclosure improves patient, staff and community confidence in how the system responds to patient safety incidents, and is fundamental to maintaining or re-building the trust between health care staff and consumers.
The Open Disclosure program provides a framework for effective open disclosure discussions and resources to support clinicians and managers to practice open disclosure. The importance and benefits of open disclosure are reinforced and concerns that clinicians may have about participating in open disclosure are addressed.
The program covers the essential elements of open disclosure, with a focus on improving communications between a patient (and/or his or her support person) and health care staff when the outcome of health care was not what was expected.
Open disclosure begins with the identification of any patient safety incident, and concludes when the patient and/or their support person indicate that they are satisfied that no further discussions are needed, or when they are provided with avenues to address any ongoing concerns.
The open disclosure process facilitates appropriate resolution for patients, their support people and health care staff involved. It supports valuable system improvements, through contributing to the prevention of recurrence of patient safety incidents. It is an integral part of incident management in NSW Health Services and is a key element of the early response and investigation of serious patient safety incidents.
Open disclosure is:
- A patient's and consumer's right
- A core professional requirement of ethical practice and an institutional obligation
- A normal part of an episode of care should the unexpected occur
- A critical element of clinical communications
- An attribute of high-quality health services and an important part of health care quality improvement.
The CEC Open Disclosure Handbook has been prepared as a resource for clinicians and other health care staff. It includes chapters on the two stages of open disclosure (clinician disclosure and formal open disclosure), apologising and saying sorry, support for staff, legal and insurance FAQs, and open disclosure in specific circumstances.
- CEC Open Disclosure Handbook PDF ~4.0MB
The NSW Health Open Disclosure Policy (PD2014_028) sets out the minimum requirements for implementing consistent open disclosure processes within NSW health services, describes when open disclosure is required, defines the two stages of open disclosure, outlines the key steps and outlines the key responsibilities of health care staff in relation to open disclosure.
- Changes in PD2014_028 PDF ~236KB
The Clinical Excellence Commission sincerely thanks all members of the open disclosure working party who contributed their time and expertise to the revision of the open disclosure policy and the content of the open disclosure handbook. The working party includes health consumers, clinicians and representatives from clinical governance, the Ministry of Health Legal and Finance branches, the Health Care Complaints Commission, medical defence organisations, NSW Treasury Managed Funds, insurers and the Clinical Excellence Commission's Clinical Governance, Patient Based Care and Patient Safety directorates.