Open disclosure

The ethics of open disclosure of errors are crystal clear and expressed in many clinical codes of ethics. Here is an example from the American Medical Association ... 

If an adverse event occurs, the hospital needs to follow a process of open disclosure. This means that the patients and their family or carers are told, as soon as possible after the event, what has happened and what will be done about it. An important part of the process is finding out exactly what went wrong, why it went wrong and actively looking for ways to stop it happening again. 

THE AUTHOR, CHARLES VINCENT, ACKNOWLEDGES THE VALUABLE WORK OF THE OFFICE OF SAFETY AND QUALITY IN HEALTHCARE (OSQH) AT THE WESTERN AUSTRALIAN DEPARTMENT OF HEALTH IN DEVELOPING THE WA OPEN DISCLOSURE POLICY COMMUNICATION AND DISCLOSURE REQUIREMENTS FOR HEALTH PROFESSIONALS WORKING IN WESTERN AUSTRALIA (2009) ON WHICH THIS OPEN DISCLOSURE PATIENT INFORMATION PAMPHLET IS BASED. CHARLES VINCENT THANKS THE OSQH FOR PERMISSION TO USB THIS DOCUMENT)... 

BOX 9.4 Characteristics of a good open disclosure process as identified by patients and their families... 

Lack of demonstrated good stories on how to practice open disclosure well. Professional factors... 

Debate about when open disclosure is needed ... 

Perceptions that open disclosure is another bureaucratic imposition ... 

Questioning of patients motive in seeking open disclosure. 

From the little information available, it does seem clear that those organizations that have followed the path of open disclosure have not been overwhelmed by lawsuits. To the contrary, the experience has been positive and they have argued strongly for others to follow. One hospital in the United States initiated a policy of open disclosure in 1987, deciding to both take a more proactive approach to managing defensible claims and also to come forward and acknowledge when a serious error had been made. This commendable ethical position has led to five major settlements over the years of cases where... 

Provide clear guidelines for discussion of error with patients backed up by board level policy on open disclosure. 

Australian Coimcil for Safety and Quality in Health Care 2003. Open Disclosure Standard A National Standard for Open Communication in Public and Private Hospitals, Following an Adverse Event in Health Care. Commonwealth of Australia Publications no 3320. 

Medical accident, especially when it harms a patient, is a defining moment for an organization. How such an event is managed both expresses and shapes the culture of the organization. When we mean to do well but harm results, we have failed the patient and the patient s family. An accident also affects the care providers at the sharp end, the point of care where technical work is done. It is a devastating event. How the organization responds can reinforce a culture of secrecy and blame, or it can advance a culture of safety, characterized by open disclosure, analysis, learning, prevention, and face-to-face accountability. 

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