Ethics Training Needs to Emphasize Disclosure and Apology

Wojcieszak, Doug; Saxton, James W.; Finkelstein, Maggie M

doi:10.1007/s10730-008-9077-2

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…In the USA this is the basis of a series of 'apology laws' that prohibit or limit the use of an apology in the case against a health professional or organisation in litigation. [124][125][126] At least 36 states have passed, and others are considering passing, immunity for apology laws and five states have passed mandatory disclosure laws. 127 However, there continue to be a number of authors who warn individual clinicians to be wary of making an admission of liability during the open disclosure process.…”

Section: Apology Lawsmentioning

confidence: 99%

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Birks

Harrison

Bosanquet

et al. 2014

Health Services and Delivery Research

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BackgroundIn 2009 the UK National Patient Safety Agency relaunched its Being Open framework to facilitate the open disclosure of adverse events to patients in the NHS. The implementation of the framework has been, and remains, challenging in practice.AimThe aim of this work was to both critically evaluate and extend the current evidence base relating to open disclosure, with a view to supporting the implementation of a policy of open disclosure of adverse events in the NHS.MethodsThis work was conducted in three phases. The first phase comprised two focused systematic literature reviews, one summarising empirical research on the effectiveness of interventions to enhance open disclosure, and a second, broader scoping review, looking at reports of current opinion and practice and wider knowledge. The second phase involved primary qualitative research with the objective of generating new knowledge about UK-based stakeholders’ views on their role in and experiences of open disclosure. Stakeholder interviews were analysed using the framework approach. The third phase synthesised the findings from the first two phases to inform and develop a set of short pragmatic suggestions for NHS trust management, to facilitate the implementation and evaluation of open disclosure.ResultsA total of 610 papers met the inclusion criteria for the broad review. A large body of literature discussed open disclosure from a number of related, but sometimes conflicted, perspectives. Evidential gaps persist and current practice is based largely on expert consensus rather than evidence. There appears to be a tension between the existing pragmatic guidance and the more in-depth critiques of what being consistent and transparent in health care really means. Eleven papers met the inclusion criteria for the more focused review. There was little evidence for the effectiveness of disclosure alone on organisational or individual outcomes or of interventions to promote and support open disclosure. Interviews with stakeholders identified strong support for the basic principle of being honest with patients or relatives when someone was seriously harmed by health care. In practice however, the issues are complex and there is confusion about a number of issues relating to disclosure policies in the UK. The interviews generated insights into the difficulties perceived within health care at individual and institutional levels, in relation to fully implementing the Being Open guidance.ConclusionsThere are several clear strategies that the NHS could learn from to implement and sustain a policy of openness. Literature reviews and stakeholder accounts both identified the potential benefits of a culture that was generally more open (not just retrospectively open about serious harm). Future work could usefully evaluate the impact of disclosure on legal challenges within the NHS, best practice in models of support and training for open disclosure, embedding disclosure conversations in critical incident analysis and disclosure of less serious events.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Apology Lawsmentioning

confidence: 99%

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration

Birks

Harrison

Bosanquet

et al. 2014

Health Services and Delivery Research

View full text Add to dashboard Cite

show abstract

“…As mentioned, the commonly accepted principle of respect for patient autonomy means that patients should be respected as persons entitled to significant information about their health and treatment. Providers have an obligation to be honest with patients about what has occurred (Wojcieszak et al, 2008). Thus, if a patient is not informed of the occurrence of a medical error, then the patient has not been provided information possibly relevant to future treatment decisions that need to be made by that patient.…”

Section: The Moral Case For Disclosurementioning

confidence: 99%