Open Disclosure Policy
Date: 11/10/2021
Last Review: 28/03/2023; 11/10/2021
Purpose:
To encourage and engender trust between doctors and patients; and
To reduce the imbalance of information that exists between doctors and patients; and
To enable improvement by learning within our practice; and
To ensure that there is a culture of open, honest discourse about error and quality improvement in our practice.
Responsible Staff:
Implementation: Clinical Director.
Action: All staff
Audit:
There are no audits for this policy.
Training Resources:
HDC Guidance on Open disclosure
Ministry Of Health Training resource
Linked Policies:
Complaints Policy
Policy:
Right 6 of the Health And Disability Consumer's Code of Rights (The Code) includes the right to full information. This is interpreted as including open and honest disclosure of harm when it occurs, as opposed to hoping that no-one notices, finds out or complains about adverse events. This is not about apportioning blame - bad things happen even with the best of care, but it is about being honest when things have not gone as expected.
Consumers should be notified under this policy whenever their care has resulted in harm to them, and occasionally, when they may have been at risk, but harm has not occurred.
Whilst there are dfferent degrees of harm, the management of all events has common features, the FIVE A's of Adversity.
- ACKNOWLEDGE - Recognise and acknowledge the harm that has occurred. Don't hide it. Don't hope no-one will notice. Tell the patient as soon as possible that their care has not been optimal. Wherever possible this should be done by the staff member most involved in the incident.
- APOLOGISE - A sincere apology is required. This recognises the harm, which is very important for the rebuilding of trust with the patient. Whatever degree of harm is discovered apologise to the patient for the harm. This is not an admission or assignation of liability but rather a recognition that the patient has been harmed and we would like it to have been otherwise.
- ASK - Ask for feedback from the affected party and from colleagues as appropriate.
- ANALYSE - Why did this happen? Could something be done differently in future. What changes should be considered. Is there information not yet available?
- ANNOUNCE - Let the patient and your colleagues know what happened and your recommendations. Be open about what is known and where appropriate, what is yet to be discovered. Make sure the patient is given the details of the local HDC advocacy service.
Most of the time, for most incidents, it is sufficient for this process to take place at the time the harm is noted. A comment in the notes and an offer of advocacy support is enough. For more significant events, and especially where there is the possibility of a system improvement being made, a formal incident report should be created and the matter discussed with the appropriate lead - for clinical matters it should be brought to the attention of the Clinical Director. For Health and Safety to the Health and Safety lead - other matters to staff as appropriate, if in doubt, refer to the Clinical Director for advice.
More significant harm requires a written notification to the affected person or, where appropriate, their whanau. This should be in the manner one might expect had a complaint about the standard of care given been received, but should follow the 5 A's principles listed above in general form, as well as the guidance in the Complaints Policy. This should be documented in the Incident Book and also in the patient's file.
The excellent advice in the linked HDC document on Open Disclosure should guide the manner in which information is imparted. This is in part reproduced above, but staff should read and utilise this guidance in the event that there is a more significant event.
Open disclosure needs to take place in a timely fashion - ideally as soon as the matter comes to light, wherever possible within 24 hours and certainly within 5 working days of any event being recognised.
We operate a NO BLAME culture.
No human endeavour is free from mistakes. We all make them from time to time, but acknowledging them is very hard.
The act of reporting and honestly managing an open disclosure event shall not in and of itself reflect anything other than credit on the involved staff.
Change Log
28/08/23 - Added timing requirement - SEDD