<p>Open disclosure of adverse events: exploring the implications of service and policy structures on practice</p>

Abstract

PurposeThe aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia.Participants and methodsAn explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or practice levels within the state of NSW, Australia. Interviews explored the service and policy structures surrounding OD and the perceived impact of these on the implementation of the OD policy. These data were thematically analyzed to understand the factors facilitating and creating barriers to openness after adverse events.ResultsThe data identified three key areas in which greater alignment between OD policy and the wider service and policy structures may enhance the implementation of OD practice: 1) alignment between OD and root cause analysis processes, 2) holistic training that links to other relevant processes such as communicating bad news, risk management, and professional regulation and insurance, and 3) policy clarification regarding the disclosure of incidents that result in no or low-level harm.ConclusionEvidence from this study indicates that formal OD processes are not routinely applied after adverse events in NSW, despite clear guidelines for OD. The reasons for this are unclear as the service-level and policy-level phenomena that support or hinder OD are understudied. This knowledge is critical to addressing the policy-practice gap. Our paper provides insights regarding the influence of current service-level and policy-level phenomena on the delivery of OD and how policy clarification may contribute to addressing some of the challenges for implementing OD policy. The principles of virtue ethics – specifically, openness and the involvement of service users – may contribute to progressing in this area.

Nurses’ perceptions of open disclosure processes in cancer care: a cross-sectional study

“…Nurses' perceptions of the proportion of patients being told about errors as soon as they happen and getting an explanation of why the event occurred were also much lower than what was reported by outpatients in previous studies (Bryant et al, 2017;Carey et al, 2019). Although these findings are not directly comparable due to nurses reporting on a global rate of disclosure while patients in the previous study reported on a single event, the findings do align with previous research demonstrating low adherence to open disclosure processes (Finlay et al, 2013;Harrison, Walton, Smith-Merry, Manias, & Iedema, 2019;Walton et al, 2018). While examining patient-reported health care error rates remains an important area of quality assurance and patient-centred care, these rates will likely underestimate error rates in cancer clinics until open disclosure is common practice.…”

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence

“…This realist synthesis identifies five initial programme theories highlighting the factors that are required for successful OD in maternity settings from the perspective of three different interest groups (families; clinicians and services). Some of these factors have been previously identified, and are not unusual in studies of OD in general health care [ 10 , 89 – 96 ] or more recent NHS England policy interventions [ 97 ]. Our realist synthesis adds to this, contributing detailed descriptions of the barriers and facilitators to this work across the entirety of the OD process for different stakeholders.…”

“…Some of our included studies [ 6 , 48 , 76 , 78 , 83 ] considered a wider socio-political promise of OD as an ethical practice. As such, it encapsulates an ethos of care and communication with patients and families that includes consideration both of alternative forms of expertise and user entitlement [ 6 , 96 ]. This ethos is challenged in situations of poor outcome [ 76 , 101 ], when resources required to support harmed families and staff are eroded [ 95 ] and when expectations of learning for future improvement evaporate.…”

Uptake of health services by youth living with HIV: a focused ethnography

“…This could be through staff establishment of clinical incidents disclosure and an anonymous feedback system between clients, nurses, and the Ministry of Health. The open disclosure and feedback framework is known to improve professional conduct and quality of care in the United States, Australia and United Kingdom (Harrison et al, 2019, Harrison et al, 2017). The community health providers need to work with and sensitize the community, group leaders and parents to accept and encourage youth to participate in activities that reduce HIV transmission.…”