title: Enacting open disclosure in the UK National Health Service: A qualitative exploration.
abstract: BACKGROUND
  Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure.
  
  
  METHODS
  Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach.
  
  
  RESULTS
  Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity.
  
  
  CONCLUSIONS
  Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.
authors.affiliation: University of New South Wales, New South Wales, 2052, Australia.
authors.forename: Reema
authors.identifier: http://orcid.org/0000-0002-8609-9827
authors.initials: R
authors.lastname: Harrison
authors.affiliation: Social Policy Research Unit, University of York, York, YO10 5DD, United Kingdom.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Birks
authors.affiliation: Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom.
authors.forename: Kate
authors.initials: K
authors.lastname: Bosanquet
authors.affiliation: Centre for Health Research and Implementation, Monash University, Wellington Rd & Blackburn Rd, Clayton, Victoria, 3800, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
mesh_terms: D003142:Communication; D006801:Humans; D007407:Interviews as Topic; D007603:Jurisprudence; D019300:Medical Errors / Q000523:psychology*; D009014:Morals; D009313:National Health Programs / Q000941:ethics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D009726:Nurses / Q000523:psychology*; D010465:Perception; D010820:Physicians / Q000523:psychology*; D057766:Policy; D024382:Professional Role; D036301:Qualitative Research; D014342:Truth Disclosure / Q000941:ethics*; D006113:United Kingdom
keywords: adverse events; being open; hospitals; incident disclosure; medical error; open disclosure