Putting policy into practice
Establish formal procedures
From the organisational perspective, there should be a clearly stated policy and procedure about open disclosure, which should be consistent with the existing clinical governance framework, quality and safety policies and procedures, supported by senior health professionals using the process, and consistent with corporate direction and government regimes, insurer requirements and employment obligations.
Health services should ensure the procedure that triggers the open disclosure process is in place whenever an adverse event occurs. The disclosure process should incorporate the “no blame” (or “fair blame”) approach and health professionals and managers need to be consistent in their understanding of it. Engagement and culture building in the organisation about open disclosure should be multidimensional and multidirectional. Identifying and establishing local champions would be a useful start.
Healthcare professionals may fear that by being honest they will expose themselves to litigation and disciplinary action and damage to their reputation; they may feel anxious about admitting mistakes or feel incompetent to undertake an open disclosure process. They may also feel that there is a lack of managerial and institutional support if they are involved in open disclosure procedures.
Some professionals may not understand what the real purpose of open disclosure and what the real needs of the clients are; they may also be very uncertain about the do’s and don’ts and what they ought and ought not to say to patients and their families during open disclosure.
Provide emotional support and coaching
A disclosure support system has been advocated as an institution support to overcome barriers to error disclosure. The system aims to provide disclosure education, ensure disclosure coaching is available at all times and provide emotional support to the patients and family, the healthcare workers (the “second victim” in an incident), and administration. Sufficient resources should be allocated to sustain the support system. Medical staff are required to engage in disclosure activities, which are to be integrated with other patient safety and risk management activities.
Plan your response
Open disclosure is communication in a challenging setting where one might find denial, distancing, defence, guilt, blame, mistrust, high emotion, anger, confrontation, demand for compensation and a threat of a lawsuit. In the actual occurrence of an incident with the need for open disclosure, before the disclosure meeting, the care providers and relevant parties who are taking part in the disclosure should role play, practise and plan the disclosure dialogue (including crafting an apology appropriately, identifying a key spokesperson, etc), review the known current facts of the event, prepare to use plain language and consider legal presentation if appropriate.