Open Disclosure

The Open Disclosure Process

What is Open Disclosure?

Open disclosure is defined in the Australian Open Disclosure Framework [2] as:

"an open discussion or series of discussions 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."

An open disclosure discussion is required whenever a patient has been involved in a patient safety incident.


Essential elements of effective open disclosure include:

  • Apologising to the patient and/or their support person(s), including the words "I am sorry" or "we are sorry"
  • Acknowledging the patient safety incident and the impact on the patient and/or their support person(s)
  • Listening to and responding to the patient's experience, and/or that of their support person(s)
  • Discussing the potential consequences of the incident
  • Providing an opportunity for the patient and/or their support person(s) to ask questions and to have those questions answered
  • Explaining the steps being taken to manage the incident and prevent recurrence
  • Providing support for patients and/or their support person(s), and health care staff involved, to manage the physical and psychological consequences of what happened.

Clinician Disclosure

Open disclosure begins with a clinician disclosure discussion with the patient and/or their support person, within 24 hours of the patient safety incident. The purpose of clinician disclosure is to inform and support the patient and/or their support person(s) and to offer an apology for what has happened.


Checklist A Clinician Disclosure identifies the steps to be completed for the initial clinician disclosure discussion with a patient and/or his or her support person(s).


The STARS tool provides a framework for clinician disclosure discussion.


Formal Open Disclosure

Formal open disclosure is a structured process which follows on from clinician disclosure as soon as is practicable. It provides a format that facilitates effective and timely communication between the patient and/or their support person, clinicians, senior clinical leaders and the organisation.

Formal open disclosure may be required for any patient safety incident, as determined by the patient and/or their support person, the director of clinical governance (DCG) and/or the appropriate senior manager (for example the facility, operations or health service manager).


The following checklists may be useful for the different stages of Formal Open Disclosure.


Specific Circumstances

The approach to open disclosure can vary depending on the particular circumstances of the incident. Each situation should be addressed on a case-by-case basis, and advice sought, if required, from an open disclosure advisor, or a senior colleague with experience in open disclosure.


References

[2] Australian Commission on Safety and Quality in Health Care (ACSQHC) Australian Open Disclosure Framework, Sydney, 2013