Open Disclosure Policy in Australian Hospitals: A Research-Based Briefing Paper

This briefing paper discusses the open disclosure policy in Australian hospitals, its background, and its significance in promoting a culture of healthcare safety. It also provides recommendations for its implementation and communication strategies.

Running head: RESEARCH BASED BRIEFING PAPER
RESEARCH BASED BRIEFING PAPER
Name of the Student
Name of the university
Author’s note

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Issues Brief
PREPARED FOR: Director-General of health
REQUESTED BY: Director-General of health
PREPARED BY:
DATE:
Issue Statement: Quality and Safety in Australian Hospital in relation
to Open Disclosure
Background and Discussion
The open disclosure policy was the outcome of a trial that took place in USA in the year
1987, in a veteran hospital, where the main aim was to disclose the reason for harm to the
patient. The outcomes were positive which lead to the formation of Open disclosure policy
(Watson et al, 2015).
Open disclosure had been adopted by a number of nations like Australia, Canada, New
Zealand and United Kingdom. The open disclosure standards were endorsed by the government
of Australia in the year 2003, which was the first national open disclosure policy (Watson et al,
2015).
Open disclosure policy may be defined as the open discussion of the adverse events that
may harm a patient while receiving the health care with the patient, carers and the family. The
open disclosure standard was a disclosure on part of the Australian council for health and safety
in Health care (Eaves-Leanos & Dunn, 2012). The main aim of this standard was to promote a

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transparent and a consistent approach by the organizations for open communications with the
patients and their nominated person following an adverse event. One of the main aims of this
policy is to mitigate the risks of adverse events by using the information to improve clinical
setting and promote a culture focusing on health care safety.
The main elements of the open disclosure are:-
 Apology including words of sympathy and anticipation like 'We are sorry" or 'I am sorry'.
 A valid and factual explanation of the event.
 Discussion regarding the potential consequences of the adverse events (McLennan &
Truog, 2013)..
Open disclosure can have a significant effect in the healing and restoration of trusts if the
harm is acknowledged. Patient may undergo through physical and emotional trauma
following an adverse event, which may affect his or family and carers as well (Eaves-
Leanos & Dunn, 2012). Open disclosure helps to lift the burden form the patient or the
family's shoulder. According to Finlay et al.,(2013), when health plan does not go
accordingly, patients wants to know what happened and the reason. They try to
understand whether there is any genuine regret for the wrong and whether any further
action had been taken or not to minimize the risk (McLennan & Truog, 2013).
For a clinician it can be utterly confusing whether to disclose the information when an adverse
event had occurred. It has to be kept in mind that participation in open disclosure does not breach
the standards of professional conduct or the institutional insurance (Guillod, 2013). The open
disclosure is an accrediting step in the National Safety and Quality Health Service Standards
(NSQHS Standards).

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OD had been included in the Australian doctor's code of conduct. This policy had been
consolidated in various parts of Australia.
The open disclosure policy has been accepted by a number of health care settings, such as
the New South Wales Clinical Excellence Commission the Queensland’s Health Quality and
Complaints Commission (Department of Health and Human service, 2015). The royal
Australasian college of surgeons has accepted the open disclosure policies and has adopted the
policies actively (Australian Commission on Safety and Quality in Healthcare, 2012).
Although the apology law varies from state to territories, the main is to adopt the method of
open disclosure. The laws of apology are different in different states as provided in the appendix
(appendix 1). For example, the open disclosure comes under the civil liability act in Tasmania,
and it comes under wrong's act in Victoria. Patients value apologies and expressions of empathy,
remorse and caring (Australian Commission on Safety and Quality in Healthcare, 2012). Reports
suggest that immediate disclosure of medical error could create an environment where the
communication is repeated and can accommodate the shifting perspective of those who have
experienced the mistake.
The undertaking of the O.D policies in Australia has reduced the number of cases of patient
harm. People have provided with feedbacks, which O.D makes it easier to prepare themselves for
future adverse consequences (Department of Health and Human service, 2015).
Breaching of the open disclosure procedures would break the trust between the client and the
caregivers. In that case clients can take legal steps against the organization or the client might get
into an emotional turmoil.
Options and/or Recommendations:

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 It is necessary to make OD a routine part of the medical practice.
 The OD should be supported by strong federal laws, such that exploitations do not occur
with the OD information (McLennan & Truog, 2013).
 As far as federal laws are concerned the health care professionals were often concerned
about the fact that the information about the adverse event should be used against them in
medico-legal proceedings. Hence, the OD should be supported by a strong legal frame
work of apology laws, state and federal laws (Finlay et al., 2013).
 To follow a ' No- blame' approach.
 The clinical staffs should be acquainted with the open disclosure procedure.
 Dissemination of the initiative can be made through meetings, workshops, publishing of
relevant newsletters and posters.
 Institutions not adhering to the protocol should be penalized (Finlay et al., 2013).
 It is necessary to inform the patients regarding the support that he would get post any
adverse event (Piper et al., 2014).
 Suitable compensations against any adverse event depending upon the severity of the
event. In accordance to this, it is essential to have a prior word with the health insurance
organizations and the legal counsel (McLennan & Truog, 2013).
 Keeping an electronic record of all the sentinel events, in order to tally them with the
prior records.
 To maintain a checklist, in order to avoid the adverse situations.
 The patients should be informed about the OD policies by letters or personal calls or
patient- family brochures (Guillod, 2013).
 Proper e- learning packages for the open disclosure procedure.

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 A resource toolkit for the health services, including a staff questionnaire.
 In order to check the implementation of the policy it is essential to obtain feedback from
patients and families and preserve the documents for future evaluation.
Things to be kept in mind while interacting with the patient:-
 While communicating with the patient, it is necessary to be sensitive to the culture,
language and the communication requirement of the patient (Guillod, 2013).
 The information regarding the adverse event should be given in private, confidential
space, away from the clinical area, in a manner that would empower patient and the
family (Eaves-Leanos & Dunn, 2012).
 The clinicians should be extremely aware of the words chosen for disseminating the
information.
 Medical terminologies and jargon should be avoided.
 It should be ensured that the discussion is not interrupted.
Risks
Health care professionals were often concerned about the fact that the information about
the adverse event should be used against them in medico legal proceedings. A clinician is often
plagued with the fear of losing their job, loss of respect, involvement in a lawsuit, loss of the
professional license (McLennan & Truog, 2013). The health care professional can be judged
after returning to the work. A patient might get angry or traumatized by the information of the
error on doctor's part. Hence, the OD should be supported by a strong legal frame work of
apology laws, state and federal laws (McLennan & Truog, 2013). Health professionals frequently
argue that the legal provisions become burdensome to them and thus should be replaced by some

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professional guidelines. Whereas most of the researchers argue that the patient safety can be
brought by the tort system. Considering the financial implication of the policy, medical errors
can increase the compensatory burden on the health care setting.
Source: (Guillod, 2013).
Implementation
System changes can be implemented in a relatively short time frame but cultural transformation
would comparatively take a longer time frame.

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Possible ways of implementation of the open disclosure policy
The managers, operational heads, the doctors, clinical staffs and the legal aspects would be
responsible for disclosing the errors.
Leadership
It is necessary to enlist a clinical leader who will be leading the open disclosure method. It is
important to have an explicit and vocal support from the executive and the senior leaderships of the
organization (Wu et al., 2013). Managers would be able to analyze and train the clinicians.
Support
Other clinical staffs will provide support to the one disclosing the medical error. The deploying
open disclosure and legal experts will assure and assists the staffs.
Enlistment of patients
According to Bismark et al., (2013), successes have been obtained when the patient is asked to
become the part of the solution. The clinical staffs would make list of patients on whom the policy
has to be implemented, in order to take precautions beforehand.
Training and development
A small cohort of clinical staffs should be trained as experts, who can take the responsibility of
supporting the other staffs during the open disclosure.
Presentation of a clear rationale and dispelling of the myths
The clinicians should dispel the myths regarding open disclosure (like it increases litigation).
Timeframe
It is essential to set a target time frame for the work to be implemented. This initiative should not take
more than 6 months.
Evaluation
After the completion of the open disclosure procedure, the participants should be given the
opportunity to give feedback. Quarterly audits should be made. Face to face interviews, patient

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safety and staff template can be used. The aggregate results can be given for tracking the process
over time (Eaves-Leanos & Dunn, 2012). The reduction in current cases of adverse events as
compared to the previous years will be the criteria of resolving the issue.
Communication
The federal government can take the help of media, news bulletins to disseminate the
policies among the different health care settings. It is necessary to provide a detailed description
of the policies and the laws involved, including the tort laws and the penalties (Watson et al.,
2015).
The recommendations have to be communicated to the doctors and the clinical staffs. The
communication plan has to be approved by the organizational heads (Watson et al.,2015).
The method of communication that can be used in this process includes meetings,
telephone calls, memos, emails, newsletters. A clear communication with the stakeholders is
necessary to implement open disclosure in a clinical setting. According to Watson et al.,(2015),
the executive sponsor, the open disclosure support staffs, patient safety manager and senior
clinicians should take active participation in the dissemination process.

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References
Australian Commission on Safety and Quality in Healthcare, (2012).Open Disclosure
Standard Review Report, Sydney, Australia. https://www.safetyandquality.gov.au/wp-
content/uploads/2013/05/Open-Disclosure-Standard-Review-Report-Final-Jun-2012.pdf
Bismark, M. M., Walter, S. J., & Studdert, D. M. (2013). The role of boards in clinical
governance: activities and attitudes among members of public health service boards in
Victoria. Australian Health Review, 37(5), 682-687. https://doi.org/10.1071/AH13125
Department of Health and Human services. (2015). Open disclosure following adverse events in
Victorian health services. [online] Available at:
https://www2.health.vic.gov.au/hospitals-and-health-services/quality-safety-service/
clinical-risk-management/open-disclosure#
Eaves-Leanos, A., & Dunn, E. J. (2012). Open disclosure of adverse events: transparency and
safety in health care. Surgical Clinics of North America, 92(1), 163-177.
https://doi.org/10.1016/j.suc.2011.11.001
Finlay, A. J., Stewart, C. L., & Parker, M. (2013). Open disclosure: ethical, professional and
legal obligations, and the way forward for regulation. The Medical Journal of
Australia, 198(8), 445-448. doi: 10.5694/mja12.10734
Guillod, O. (2013). Medical error disclosure and patient safety: legal aspects. Journal of public
health research, 2(3). doi: 10.4081/jphr.2013.e31
McLennan, S. R., & Truog, R. D. (2013). Apology laws and open disclosure. The Medical
Journal of Australia, 198(8), 411-412. doi: 10.5694/mja12.11339

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Piper, D., Iedema, R., & Bower, K. (2014). Rural patients' experiences of the open disclosure of
adverse events. Australian journal of rural health, 22(4), 197-203.
DOI: 10.1111/ajr.12124
Watson, B. M., Angus, D., Gore, L., & Farmer, J. (2015). Communication in open disclosure
conversations about adverse events in hospitals. Language & Communication, 41(Mar),
57-70. doi:10.1016/j.langcom.2014.10.013
Wu, A. W., Boyle, D. J., Wallace, G., & Mazor, K. M. (2013). Disclosure of adverse events in
the United States and Canada: an update, and a proposed framework for
improvement. Journal of public health research, 2(3). doi: 10.4081/jphr.2013.e32

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Appendix:1
Legal aspects of open disclosure policy by the state and the territory

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Appendix 2
Communication plan
Audience Message Media Frequency Timing Responsibility
The
Government
To legalize the
open disclosure
method
By passing
bills, statutory
laws, tort laws,
penalties
Once As per the
requirement
Ministry of
health
The state
government
Implementatio
n of OD in all
health care
settings over
the state
Newsletters,
tenders,
discussing
with the
clinical heads.
Once As per the
requirement
The ministry of
health
Health care
providers
Enforcing OD
in the clinical
settings. Enlist
the tasks that
have to be done
in the near
future.
Face to face
meetings,
brochures.
Once in a
month
As per the
requirement
Health care
organizational
head.
Committee
members
Discuss the
terms of the
new policy,
Face to face
meetings and
declaration of
Once in a
month
As per the
requirement
Managers

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discussing
about further
changes
the new
policies
through
bulletin boards
Health
Insurers
Implementatio
n of legal
procedures.
Meetings Monthly As per the
requirement
Insurance and
legal experts.