Asleep Dental Open Disclosure Policy

Adopted August 6th , 2018 for review August 2025

 

 

OPEN DISCLOSURE POLICY PURPOSE

This Policy Directive sets out the minimum requirements for a consistent open disclosure process within Asleep Dental, to ensure that patient and their support person(s) and health service staffs are:

  • Communicating effectively about a patient safety incident
  • Provided with an opportunity to recount their experiences, concerns and feelings and are listened to
  • Treated respectfully and provided with ongoing care and support for as long as is required.

 

MANDATORY REQUIREMENTS

The mandatory requirements for Health Services in the implementation of the open disclosure policy following a patient safety incident are based on the principles outlined in the Australian Open Disclosure Framework.
These principles address the complex interests of patients, clinicians, managers, Health Services and other key stakeholder groups such as healthcare consumers, medical indemnity insurers and professional organisations.

The mandatory requirements are as follows:

  1. Acknowledgement of a patient safety incident to the patient and/or their support person(s), as soon as possible, generally within 24 hours of the incident. This includes recognising the significance of the incident to the patient.
  2. Truthful, clear and timely communication on an ongoing basis as required.
  3. Providing an apology to the patient and/or their support person(s) as early as possible, including the words “I am sorry” or “we are sorry”.
  4. Providing care and support to patients and/or their support person(s) which is responsive to their needs and expectations, for as long as is required.
  5. Providing support to those providing health care which is responsive to their needs and expectations.
  6. An integrated approach to improving patient safety, in which open disclosure is linked with clinical and corporate governance, incident reporting, risk management, complaints management and quality improvement policies and processes. This includes evaluation of the process by patients and their support person(s) and staff, accountability for learning from patient safety incidents and evidence of systems improvement.
  7. Multidisciplinary involvement in the open disclosure process.
  8. Compliance with legal requirements for Privacy and Confidentiality for the patient and/or their support person(s), and staff delivering health care.

 

The Open Disclosure Policy Section 5 provides further detail about these requirements.

 

 

 

 

 

 

 

Contents

1 BACKGROUND ………………………………………………………………………………………………………..3
1.1 What is open disclosure ………………………………………………………………………………………..3
1.2 Objectives ……………………………………………………………………………………………………………3
1.3 Associated Documents ………………………………………………………………………………………….3
2 KEY DEFINITIONS ………………………………………………………………………………………………4
3 IMPLEMENTATION …………………………………………………………………………………………….6
4 GOVERNANCE OF OPEN DISCLOSURE ……………………………………………………………………6
4.1 Legal and Legislative considerations ……………………………………………………………………….6
4.2 Open disclosure and the investigation of a patient safety incident ……………………………..7
4.3 Restrictions on the release of information ……………………………………………………………….7
4.4 Risk management …………………………………………………………………………………………………7

4.5 Record management …………………………………………………………………………………………….8
4.6 Processes for reimbursement of out-of-pocket expenses ………………………………………….8
5 REQUIREMENTS FOR IMPLEMENTATION OF OPEN DISCLOSURE ………………………………..8

6 THE OPEN DISCLOSURE PROCESS ……………………………………………………………………….10

6.2.1 Detection of a patient safety incident………………………………………………………………….10

6.2.2 Immediate actions…………………………………………………………………………………………….10

6.2.3 Assessment and determination of the severity of harm to the patient and the level

of open disclosure response required………………………………………………………………………….10

6.2.4 Initiation of open disclosure: Clinician disclosure………………………………………………….10

6.2.5 Formal open disclosure……………………………………………………………………………………..11

6.2.6 Follow-up activities – coordinated by the Open Disclosure Coordinator ………………….12

6.2.7 Completing the process …………………………………………………………………………………….12

6.2.8 Evaluation and Review ……………………………………………………………………………………..13
6.3 Open disclosure in specific circumstances ……………………………………………………………..13

6.3.1 When formal open disclosure may be considered inappropriate ……………………………13

7 REFERENCES …………………………………………………………………………………………………..14

 

 

1 BACKGROUND

1.1 What is Open Disclosure?

Open disclosure is a process for ensuring that open, honest, empathic and timely discussions occur between patients and/or their support person(s) and Health Service staff following a patient safety incident.

Open disclosure is an integral part of incident management within Asleep Dental, and is a key element of the early response and investigation of serious patient safety incidents.

Open disclosure discussions between patients and staff are required whenever a patient has been harmed, whether that harm is a result of an unplanned or unintended event or circumstance, or is an outcome of an illness or its treatment that has not met the patient’s or the clinician’s expectation for improvement or cure.

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, and a critical element of clinical communications
  • An attribute of high-quality health services and an important part of health care quality improvement.

 

1.2 Objectives

Asleep Dental is committed to providing an organisational culture of safety and quality strengthened by:

  • Creating a supportive environment in which patient safety incidents are identified and reported without attribution of blame
  • Encouraging staff to openly inform, listen to and support the patient, their support person(s), and colleagues who may have been involved in a patient safety incident
  • Sharing lessons learned from patient safety incidents to identify and develop strategies to prevent potential incidents.

 

The objectives of the Asleep Dental Open Disclosure Policy are to:

  • Establish a culture which supports open communications between patients, their support person(s) and clinicians after a patient safety incident
  • Ensure that communications with and support for all affected patients, their support person(s) and staff occur in a timely and empathic manner
  • Ensure that Asleep Dental has a consistent process for open disclosure.

1.3 Associated documents

  • The Australian Open Disclosure Framework is the reference document for this policy. http://www.safetyandquality.gov.au
  • Open disclosure and the respectful management of patients, families and staff is an intrinsic part of the complaints management and incident management process. This policy should be read in conjunction with the following policies and guidelines:

– Policy on Incident Management

– Your Health Rights and Responsibilities

– Policy on Complaint Management

– Guideline on Complaint Management

– Policy on Standard Procedures for working with Health Care Interpreters

– Respecting the Difference – An Aboriginal Cultural Training Framework

– Policy and Implementation Plan for Culturally Diverse Communities 2012 –

2016

– Policy on Complaint or Concern about a Clinician – Principles for Action

– Complaint or Concern about a Clinician – Management Guidelines

Other related policies and resources are listed in 8.1.

  • Open Disclosure is mandated in the National Safety and Quality Health Service

Standards (NSQHS) Standards (Standard 1, Criterion 1.16 – Implementing an open disclosure process based on the national open disclosure standard2) and is subject to accreditation.

2 KEY DEFINITIONS

Apology: An apology is an expression of sympathy or regret, or of a general sense of benevolence or compassion, in connection with any matter whether or not the apology admits or implies an admission of fault in connection with the matter3. It should also acknowledge the consequences of the situation to the recipient4.

It must include the words “I am sorry” or “we are sorry”.

The effect of apology on liability:

(1) An apology made by or on behalf of a person in connection with any matter alleged to have been caused by the person:

(a) Does not constitute an express or implied admission of fault or liability by the person in connection with that matter, and

(B) is not relevant to the determination of fault or liability in connection with a matter.

(2) Evidence of an apology made by or on behalf of a person in connection with any matter alleged to have been caused by the person is not admissible in any civil proceedings as evidence of the fault or liability of the person in connection with that matter.

Clinician: A health care provider who is trained as a health professional, and who provides direct patient care.


Clinician Disclosure: An informal process where the treating clinician discusses with a patient and/or their support person(s) the occurrence of a patient safety incident; actively seeks input and feedback from, and listens to, the patient and/or their support person(s); and provides an apology for the occurrence of the event5.

Clinician disclosure is required whenever a patient has been harmed as a result of receiving treatment or care, and may be required if there is a potential for harm to result from ongoing risk.

Formal Open Disclosure:  A structured process which follows on from clinician disclosure, to ensure effective communications between the patient and/or their support person(s), the senior clinician and the organisation occur in a timely manner.

Formal open disclosure may be required for any patient safety incident, as determined by the Director of Clinical Governance and/or the Facility/Operations/Service Manager, the patient and /or their support person(s).

 

Harm: Impairment of structure or function of the body and/or any deleterious effect arising there from, including disease, injury, suffering, disability and death.

Harm may be physical, social or psychological.

 

Health care facility: For the purpose of this policy, a health care facility is any facility or service that delivers health care services. Health care facilities include hospitals, multipurpose services, Dental Clinics, aged care facilities, emergency services, ambulatory care services, aboriginal medical services, community health services, ambulance stations and community based health services such as needle and syringe programs.

 

Open Disclosure:

Open disclosure is defined in the Australian Open Disclosure Framework as “an open discussion with a patient (and/or their support person(s)) about a patient safety incident which could have resulted, or did result in harm to that patient while they were receiving health care. Essential elements of open disclosure are:

  • An apology
  • A factual explanation of what happened
  • An opportunity for the patient to relate their experience
  • A discussion of the potential consequences
  • An explanation of the steps being taken to manage the event and prevent recurrence.

The open disclosure process is a discussion between two parties and may include a series of discussions and exchanges of information that take place over several meetings.”

 

Open Disclosure Advisor: A senior staff member specially trained in advanced empathic communications skills, which is available to support formal open disclosure in a health facility or service.
Within Asleep Dental these people are: Dr Jeffrey Field, Jane Gravestocks (RN) and Rebecca Ough (Senior DA)

 

Open Disclosure Coordinator: A staff member who has responsibility for coordinating and supporting clinician and formal open disclosure in a health facility or service.

*Within Asleep Dental the Advisor and Coordinator will the be same person on a case by case basis

 

Patient: For the purposes of this policy, the term ‘patient’ is used to represent any person receiving health care, and may include the terms ‘consumer’, ‘resident’ and ‘client’.

 

Patient safety incident: Any unplanned or unintended event or circumstance which could have resulted, or did result in harm to a patient. This includes harm from an outcome of an illness or its treatment that did not meet the patient’s or the clinician’s expectation for improvement or cure.

Harmful incident: a patient safety incident that resulted in harm to the patient, including harm resulting when a patient did not receive their planned/expected treatment.

No harm incident: a patient safety incident which reached a patient but no discernible harm resulted.

Near miss: a patient safety incident that did not reach the patient, and/or in which a potential for harm from ongoing risk may result.

 

Staff Any person working in any capacity within Asleep Dental, including contractors, students and volunteers.

 

Support person A person who has been identified by the patient as someone whom they would like to be present to provide assistance, comfort and support during the open disclosure process and to whom information about their health care can be given. A support person may be (but is not limited to) a family member, partner, carer or friend.

Only the patient can determine who will be their support person(s). In cases of a dispute about who should receive information, the patient’s wishes should be paramount.

Where a patient does not have capacity to decide for themselves or is deceased an “authorised representative” can decide on their behalf.

A nominated next of kin is not necessarily an authorised representative.

 

3 IMPLEMENTATION
All critical incidents will be disclosed by the supervising clinician, aided by the Nursing supervisor as well as the senior/supervising Dental assistant as required.

4 GOVERNANCE OF OPEN DISCLOSURE

4.1 Legal and Legislative considerations

Open disclosure:

  • Is a dialogue between two parties
  • Is not a legal process
  • Does not imply that an individual or service has blameworthy facts to disclose.
  • Apology: Civil Liability Act 2002 Sections 67- 69
  • Protection for quality assurance activities: Health Administration Act 1982 (Part 2

Divisions 6B and 6C)

  • Public access to information: Government Information (Public Access) Act 2009
  • Privacy: Health Records and Information Privacy Act 2002; Privacy and Personal

Information Act 1998

  • Coronial investigations: Coroners Act 2009 No 41

Clinicians, health service managers and staff requiring assistance with participating in open disclosure processes may seek advice from:

  • Medical Defence Organisations or professional indemnity insurers – for those who have the relevant insurance cover
  • Their Local Health District Clinical Governance Unit and/or Manager responsible for insurable risk
  • The Clinical Excellence Commission
  • The Treasury Managed Fund (TMF) once a formal claim is initiated.

 

All practitioners should also be aware of the need to notify the Treasury Managed Fund or their professional indemnity insurer in accordance with that organisation’s requirements for timely notification of incidents.

 

*All incidents will be disclosed in a timely manner – this may follow and may precede advice from our medical legal team

 

4.2 Open disclosure and the investigation of a patient safety incident

When a patient has been harmed as the result of any patient safety incident, an investigation into the incident must commence as soon as practicable. The circumstances of the incident, including the severity of harm and/or distress experienced by the patient and their support person(s), will determine the level and method of investigation. The findings from each investigation into a patient safety incident are an essential part of the information that is provided to a patient and their support person(s) during the open disclosure process.

Patients and/or their support person(s) are encouraged to participate in the ongoing investigation process. If they choose to do so, Asleep Dental should provide appropriate support to enable this to occur.

 

All disclosable incidents will be investigated and reported within a 7 day period

 

4.3 Restrictions on the release of information

There are some restrictions on the information that can be released during open disclosure discussions.

Any information required by a third party must fall within the Victorian Privacy Act Guidelines.

 

4.4 Risk management

Preparation for open disclosure of a patient safety incident requires careful consideration and assessment of risks – to the Health Service, the patient, their support person(s), and staff, including the risk of media exposure or litigation. Undertaking risk management processes should not delay appropriate and timely open disclosure.

Implementing effective open disclosure requires that each Health Service operates within the integrated risk management and quality improvement processes. Identifying and learning from the underlying causes of patient safety incidents, complaints and claims, with the aim of implementing solutions to prevent recurrence adds value to both risk management and quality improvement.

A risk management plan needs to be developed to address identified risks. Any risk that is beyond a staff member’s capacity or delegation of authority needs to be escalated to a higher level of management for acceptance and management of the risk.

Implementation of a risk management framework in line with standards established by the Australian/New Zealand Standard Risk Management Principles and Guidelines AS/NZS ISO 31000:2009 provides a systematic process that determines when, how and by whom recommended actions and lessons learned should be cascaded, addressed and monitored.

Open disclosure must be managed to completion irrespective of other circumstances occurring at the same time for example, commencement of HCCC, coronial or legal proceedings.

 

4.5 Record management

If open disclosure is initiated with the patient and/or their support person(s) following any patient safety incident, including near misses and no harm incidents, the clinician responsible for the care of the patient must record that fact in the patient’s health care record. Once the incident is notified in the incident management system, the notifier must document the unique identification (ID) number in the health record.

For formal open disclosure it is recommended that all records associated with the open disclosure process are kept together, for example, records of meetings and outcomes.

Patient safety incidents notified to the Ministry of Health using a Reportable Incident Brief (RIB) require that a record of whether open disclosure has occurred is made in the incident management system. The ID number must be documented in the patient’s health record with the information about the patient safety incident.

Where open disclosure has occurred, managers should record that fact in the notes section of the incident management system. Health Services should establish a system for recording the open disclosure process including outcomes.

 

4.6 Processes for reimbursement of out-of-pocket expenses

Open disclosure is most effective if it is coupled with restorative action where appropriate. Early recognition and approval for reimbursement for out-of-pocket expenses incurred as a direct result of a patient safety incident sends a strong signal of sincerity. Evidence suggests that restorative action can be a determining factor in a person’s decision not to litigate. Practical support offered through reimbursement does not imply responsibility or liability. Out-of-pocket expenses may include, but are not limited to, accommodation, meals, travel and childcare.

Offers of reimbursement are made at the discretion of the Dr Jeffrey Field and other practices involved and on a case-by-case basis.

If the patient or support person(s) requests reimbursement for a significant amount, the patient or support person(s) should be advised to put their request in writing.

 

5 REQUIREMENTS FOR IMPLEMENTATION OF OPEN DISCLOSURE

Effective implementation of open disclosure contributes to improving the quality and safety of Health Services and requires an organisational focus on developing a safe and just culture, and fostering effective communications.

The Australian Open Disclosure Framework outlines principles which guide an effective open disclosure process. These principles address and balance the complex interests of patients, clinicians, managers, Health Services and other key stakeholder groups such as health care consumers, medical indemnity insurers and professional organisations.

The mandatory requirements for Health Services in the implementation of open disclosure are based on these principles and are as follows

  1. Acknowledgement of a patient safety incident to the patient and/or their support person(s), as soon as possible after the incident has occurred and any immediate action needed to support the patient’s care has been taken, generally within 24 hours.

This includes recognising the significance of the incident to the patient, even if there has been no or minimal clinical impact arising from the incident.

  1. Truthful, clear and timely communications on an ongoing basis as long as required to appropriately support the patient and/or their support person(s) and health care staff involved in the incident. This involves (a) providing information to the patient and their support person(s), (b) providing an opportunity for the patient and their support person(s) to recount their experiences, concerns and feelings, and (c) listening and responding appropriately to the patient and/or their support person(s).
  2. Providing an apology to the patient and/or their support person(s) as early as possible, including using the words “I am sorry” or “we are sorry”.

Communications that go part way towards meeting the essential elements of an apology and which may be appropriate in some circumstances, for example at clinician disclosure before the incident investigation process has been completed and where all relevant facts are not known yet, include the following:

  • Expressions of sympathy or empathy, for example “I’m sorry this happened to you”
  • Expressions of regret for the act or its outcome, for example “I regret that this happened”
  • Expressions of sorrow, for example “I’m very sorry for what has happened”.
  1. Providing ongoing care and support to patients and/or their support person(s) which is considerate of their needs and expectations, for as long as is required, so that they:
  • Are fully informed of the facts surrounding a patient safety incident and its consequences
  • Are treated with empathy, respect and consideration
  • Are supported in a manner appropriate to their needs
  • Continue to receive appropriate treatment, including if the patient and/or their support person(s) request that the patient’s health care needs are taken over by another team.
  1. Providing support to health care staff when they have been involved in a patient safety incident which respects their needs and expectations, in an environment in which all staff are:
  • Able to recognise and encouraged to report patient safety incidents
  • Prepared through training and education to participate in open disclosure
  • Supported following involvement in a patient safety incident, and/or are able to support colleagues who have been involved in an incident
  • Supported throughout open disclosure, for as long as those processes continue.
  1. An integrated approach to improving patient safety, in which open disclosure is linked with clinical and corporate governance, incident reporting, risk management and quality improvement policies and processes. This includes evaluation of the process by patients and their support person(s) and staff, accountability for learning from patient safety incidents and evidence of systems improvement.
  2. Multidisciplinary involvement in open disclosure, reflecting that most health care provision is through multidisciplinary teams and patient safety incidents are usually the result of systems failures rather than the actions of an individual.
  3. Compliance with legal and ethical requirements for privacy and confidentiality for the patient and/or their support person(s), and health care staff.

6 THE OPEN DISCLOSURE PROCESS

Open disclosure begins with the recognition that a patient has been harmed or will potentially be harmed by an ongoing safety risk as a result of receiving or not receiving treatment or care.

Open disclosure may be ongoing, involving multiple disclosure conversations over time. Open disclosure involves two-way communications. The input and perspective of the patient and their support person(s) should be actively sought and welcomed in determining what happened, the impact on the patient and/or their support person(s) and in planning for any ongoing care requirements.

 

6.1 When to disclose?

 

A disclosure discussion must occur whenever a patient has been harmed, whether that harm is a result of an unplanned or unintended event or circumstance, or is an outcome of an illness or its treatment that has not met the patient’s or the clinician’s expectation for improvement or cure. This includes disclosure when a patient has been harmed because they did not receive their planned/expected treatment.

The open disclosure process begins with clinician disclosure. The process may progress to formal open disclosure for any patient safety incident, as determined by the Director of Clinical Governance (DCG) and/or the Facility/Operations/Service Manager, the patient and/or their support person(s).

In the case of a near miss disclosure is discretionary, based on whether it is felt the patient would benefit from knowing, for example, if there is a residual safety risk. To guide decisions about open disclosure, expert advice may be required to assist with the determination of the level of risk. The timeliness of informing patients must always be considered.

All patient safety incidents should be appropriately investigated to understand all of the contributing factors involved. Being transparent about what happened, as well as how and why it happened, is very important for the understanding of patients and/or their support person(s) and health care providers.

6.2 Key steps in the open disclosure process include:

6.2.1 Detection of a patient safety incident

6.2.2 Immediate actions

  • Ensuring personal safety
  • Providing clinical care and support for the patient and safeguarding against further harm
  • Providing support for clinicians and other health service staff
  • Notifying relevant people, authorities and organisations

 

6.2.3 Assessment and determination of the severity of harm to the patient and the level of open disclosure response required

6.2.4 Initiation of open disclosure: Clinician disclosure

When a patient has been involved in a patient safety incident, the patient and/or their support person must be informed as soon as possible. The initial clinician disclosure discussion should occur at a time which meets the needs of the patient and/or their support person(s), generally within 24 hours of the incident.

  1. Preparation for discussion with the patient and/or their support person(s) includes assessing and preparing for any cultural considerations or special circumstances which may impact on the open disclosure meeting.
  2. The clinician disclosure discussion with the patient and/or their support person(s) involves:
  • Acknowledging and explaining (if the cause is known) the patient safety incident and its impact on the patient
  • Offering an apology, including using the words “I am sorry” or “we are sorry”
  • Providing an opportunity for the patient and their support person(s) to relate their experiences, concerns and feelings and to ask questions
  • Listening and responding appropriately
  • Agreeing on a plan for care which may include ongoing support and further discussions or meetings.

Practical support, for example an offer to reimburse out-of-pocket expenses incurred by a patient and/or their support person(s), may be discussed at this time or at a future meeting. An early offer of reimbursement sends a strong signal of sincerity.

6.2.5 Formal open disclosure

Formal open disclosure follows on from clinician disclosure and may be required for any patient safety incident. Within Asleep Dental this could involve the Nursing Supervisor and Supervising Dental Assistant.

Formal open disclosure should begin as soon as practicable. Establishing effective early communication with the patient and/or their support person(s) is paramount, even if the investigation process has not yet been completed and the information available is limited.

 

  1. Preparing for formal open disclosure includes:
  • Appointing the open disclosure coordinator
  • Forming the open disclosure team
  • Identifying a senior staff member experienced in open disclosure who will take responsibility for leading the discussion
  • Contacting an Open Disclosure Advisor to provide necessary support to the team throughout the process

Open disclosure may be completed after this discussion, with the agreement of the patient and/or their support person(s).

  • Providing information gathered about the patient safety incident during previous discussions with the patient and/or their support person(s) (for example, during clinician disclosure or incident investigation)
  • Liaising with the patient and/or their support person(s) to arrange:

o the time and place for the disclosure discussion/s

o who should be there during the disclosure discussion/s

  • Assessing whether there are any cultural considerations or special circumstances which may impact on the open disclosure meeting and which require additional preparation
  • Preparing information for the patient and/or their support person(s) in an appropriate format.
  1. Conducting the formal open disclosure discussion with the patient and/or their support person(s) and the open disclosure team involves:
  • Confirming acknowledgement of the patient safety incident and its impact on the patient and/or their support person(s)
  • Reaffirming or expanding on previous explanations given of the incident, using only known facts
  • Reaffirming an apology, including the words “I am sorry” or “we are sorry”
  • Explaining the formal open disclosure process
  • Providing an opportunity for the patient and/or their support person(s) to relate their experiences, concerns and feelings, and to ask questions
  • Listening and responding appropriately
  • Disclosing the findings of any review/investigation that are available at that time and a summary of factors that contributed to the patient safety incident, recommended actions, and any limitations on the information that can be provided
  • Avoiding speculation, attribution of blame, denial of responsibility or providing conflicting information
  • Agreeing on a plan for care which may include ongoing support and further discussions or meetings

An offer of practical support, for example an offer to reimburse out-of-pocket expenses incurred by a patient and/or their support person(s), may be raised at this time if not already discussed. A prompt offer of reimbursement sends a strong signal of sincerity.

6.2.6 Follow-up activities – coordinated by the Open Disclosure Coordinator

  • Ongoing discussions between the patient and/or their support person(s) and the open disclosure team leader
  • Open disclosure team review and discussion
  • If not already done, informing the patient and/or their support person(s) of the findings of the review/investigation including a summary of factors that contributed to the patient safety incident and the recommended actions
  • If not already done, liaising with the manager responsible for insurable risk on a case-by-case basis to coordinate an offer of reimbursement for out-of-pocket expenses incurred by patients and/or their support person(s) as a direct result of the patient safety incident – see section 4.5.

6.2.7 Completing the process

  • Communicating with primary care providers and other relevant clinicians as necessary, to ensure that appropriate ongoing care and support is provided to the patient and/or their support person(s) for as long as is required
  • Providing the patient and/or their support person(s) with contact details and information about ways to obtain further follow-up including being kept informed of the progress of any recommendations, and the avenues for making a complaint
  • Completing documentation, including noting in the patient’s health records that open disclosure has taken place and recording the related unique identification

(ID) used in the incident management system and/or a reference to the open disclosure file, if kept separately

  • Providing a summary of the open disclosure meetings and agreed outcomes to the patient and/or their support person(s)
  • Providing feedback to relevant staff on the final outcome of the open disclosure meeting, including any system improvements agreed with the patient and/or their support person
  • Providing opportunities for formal and informal debriefing for the clinical team and individual health care staff involved in the patient safety incident.

6.2.8 Evaluation and Review

  • Evaluating and reporting on open disclosure at a local level, including internal auditing of a sample of open disclosure processes (refer to Appendix 8.2

Measuring open disclosure for quality improvement for suggested measures for facilitating quality improvement, monitoring and reporting to management)

  • Enabling the patient, their support person(s) and health care staff to evaluate their experience of participating in open disclosure
  • Enabling the contribution of patients and/or their support person(s), and/or consumer representatives to the ongoing improvement of the open disclosure process at a local and state level
  • Including a regular review of cases requiring open disclosure at local clinical review and morbidity and mortality meetings (M and M meetings) to identify and provide advice on potential improvements to open disclosure practices
  • Sharing lessons learned from cases requiring open disclosure, including feedback provided by patients and their support person(s) and staff, and improvements to open disclosure practice.

6.3 Open disclosure in specific circumstances

The approach to open disclosure can vary depending on a patient’s personal circumstances. Each situation should be addressed on a case-by-case basis.

Advice should be sought from an Open Disclosure Advisor when open disclosure involves:

  • Death of a patient as a result of a patient safety incident, a known error or suspected suicide
  • Children and young people, patients with a mental health condition, patients with cognitive impairment
  • Patients with complex care requirements and language and/or cultural diversity
  • A breakdown in the relationship between the patient and the provider
  • Delayed detection of a patient safety incident
  • Issues of clinician accountability or suspected intentional unsafe acts.

6.3.1 When formal open disclosure may be considered inappropriate

  • The patient and their support person(s) or nominated contact person decline the offer to meet
  • The patient is incapacitated or has died and no nominated support person or authorised representative has been identified or is available
  • The nominated support person(s) or next of kin is incapacitated or is unavailable.

 

 

 

 

 

7 References

 

  • Open Disclosure Following Adverse Effects in Health Services

https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/open-disclosure
• Open Disclosure resources and tools

https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/open-disclosure/open-disclosure-resources-tools
• Open Disclosure Framework

https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/clinical-risk-management/open-disclosure/open-disclosure-framework

  • Safety and Quality Improvement Guide Standard 1: Governance for Safety and Quality in

Health Service Organisations (October 2012)

http://www.safetyandquality.gov.au/publications/rtf-safety-and-quality-improvement-guide-standard-

1-governance-for-safety-and-quality-in-health-service-organisations/

Australian Commission on Safety and Quality in Health Care, Sydney, 2012

  • Australian Commission on Safety and Quality in Health Care Open Disclosure Program

http://www.safetyandquality.gov.au/our-work/open-disclosure/

  • Australian Safety and Quality Framework for Health Care

http://www.safetyandquality.gov.au/publications/australian-safety-and-quality-framework-for-healthcare/

– Australian Commission on Safety and Quality in Health Care (ACSQHC), Sydney,

2010.
https://www.safetyandquality.gov.au/our-work/open-disclosure/

  • The Australian Charter of Healthcare Rights

http://www.safetyandquality.gov.au/publications/australian-charter-of-healthcare-rights-the/

Australian Commission on Safety and Quality in Health Care (ACSQHC), Sydney, 2009.

  • The Australian Safety and Quality Goals for Health Care

http://www.safetyandquality.gov.au/national-priorities/goals/

Australian Commission on Safety and Quality in Health Care (ACSQHC), Sydney, 2012.