Disclosing clinical adverse events to patients: can practice inform policy?
OBJECTIVE
To understand patients' and health professionals' experience of Open Disclosure and how practice can inform policy.


BACKGROUND
Open Disclosure procedures are being implemented in health services worldwide yet empirical evidence on which to base models of patient-clinician communication and policy development is scant.


METHODS
A qualitative method was employed using semi-structured open-ended interviews with 154 respondents (20 nursing, 49 medical, 59 clinical/administrative managerial, 3 policy coordinators, 15 patients and 8 family members) in 21 hospitals and health services in four Australian states.


RESULTS
Both patients and health professionals were positive about Open Disclosure, although each differed in their assessments of practice effectiveness. We found that five major elements influenced patients' and professionals' experience of openly disclosing adverse events namely: initiating the disclosure, apologizing for the adverse event, taking the patient's perspective, communicating the adverse event and being culturally aware.


CONCLUSIONS
Evaluating the impact of Open Disclosure refines policy implementation because it provides an evidence base to inform policy. Health services can use specific properties relating to each of the five Open Disclosure elements identified in this study as training standards and to assess the progress of policy implementation. However, health services must surmount their sensitivity to revealing the extent of error so that research into patient experiences can inform practice and policy development.
Faculty Nursing, Midwifery & Health, University of Technology, Broadway, Sydney, New South Wales, Australia. Roslyn.sorensen@uts.edu.au
Ros
R
Sorensen
Rick
R
Iedema
Donella
D
Piper
Elizabeth
E
Manias
Allison
A
Williams
Anthony
A
Tuckett
D001315:Australia; D003142:Communication; D054521:Cultural Competency; D006739:Hospital Administration / Q000379:methods*; D006801:Humans; D019300:Medical Errors; D011369:Professional-Patient Relations; D011640:Public Policy; D036301:Qualitative Research; D014342:Truth Disclosure