Medical Protection calls on the concept of open disclosure

12 October 2021

HSE’s proposed definitions of ‘patient safety incident’ and ‘harm’ could undermine principle of Open Disclosure

Ireland – The Health Service Executive (HSE)’s proposed definition of a ‘patient safety incident’ and ‘harm’ are too broad and could risk undermining the concept of open disclosure, according to the Medical Protection.

In its response to the consultation on HSE’s Open Disclosure Policy Revision, Medical Protection said the broad definitions as outlined in HSE’s draft policy would lead to any side effect of investigation or treatment, or any unfavourable outcome of an illness, to be categorised as a harm or a patient safety incident, and would therefore be subject to the HSE Open Disclosure Policy.

Medical Protection Society, which supports 16,000 healthcare professionals in Ireland, said this would lead to a significant and unnecessary increase in the amount of work for healthcare professionals and providers, and called on HSE to ensure the premise of a patient safety incident or harm for open disclosure purposes is instead based on error and ‘near misses’.

Dr Rob Hendry, Medical Director at Medical Protection, said:

“A mandatory open disclosure process which relies upon broad definitions of a patient safety incident or harm would be another bureaucratic endeavour adding to the ever-increasing workload and pressure for doctors. If a patient’s condition fails to improve or continues to deteriorate despite the best care and treatment, then this should not be categorised as a ‘patient safety incident’ or ‘harm’.

“Similarly, many patients will experience some degree of discomfort as a side-effect of surgery, and some patients who are prescribed medicines may experience unpleasant side effects. By the proposed definitions in the HSE’s draft policy this could be categorised as harm or a patient safety incident, and could therefore be subject to the HSE Open Disclosure Policy.

“Applying the open disclosure policy to clinical outcomes such as these is illogical and undermines the concept of open disclosure. It could also cause confusion for patients who have accepted the risks of treatment in return for its potential benefits, following discussion with the clinician prior to a treatment or procedure. Patients understand that there are rarely any guarantees when it comes to medical care and treatment; and illnesses can take unpredictable turns.

“We believe there is a strong argument for the definitions to be based on errors and ‘near misses’, so these incidents can be openly discussed and learnt from, with patients receiving an appropriate explanation and apology.

“When an adverse outcome, such as a side-effect of treatment or the natural progression of an illness, occurs, clinicians should of course engage in a dialogue with the patient. This is an established component of good medical practice and does not require categorisation as a patient safety incident under the HSE Open Disclosure Policy.

“Clinicians need to be in an environment where they feel empowered and confident to admit errors, apologise and learn from mistakes. This means no fear of blame or personal recrimination, genuine and visible support from leaders equally committed to the principles of open disclosure, and greater education on existing protections for doctors.

“If we are to achieve a truly open, learning culture which ultimately improves patient care, the HSE and others must acknowledge and address these barriers alongside its formal policies. Medical Protection also has a part to play – we stand ready to help ensure the duties on open disclosure can work for both patients and doctors.”

HSE also suggested that when a patient declines the process of open disclosure, the patient can re-open the process within five years of refusal. Medical Protection considers that the 5-year period for re-opening of the process of open disclosure is too long given the possibility that the senior clinician may have retired or changed employment. Medical Protection believes that the duration of re-opening the process of open disclosure should be reduced to 12 months.


For further information contact: Suzi Salleh | [email protected] | +44 779 080 7722

About Medical Protection

Medical Protection is a trading name of The Medical Protection Society Limited (“MPS”). MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.