Open Disclosure

Dr. Maree BellamyPrincipal Advisor, Patient Safety CEC

CEC-OpenDisclosure@health.nsw.gov.au

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Open Disclosure is about “doing the right thing”

… when a patient has been harmed while receiving health care.

It enables staff to communicate with empathy – to walk in another’s shoes – and to say sorry for what has happened.

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Drivers for Change• Revision of National Standard• Policy out of date• Response to Ombudsman• Accreditation requirements• Further research e.g. Patient Stories

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Current Status – NSW Health

– Revised policy PD2014_028 has been released – Handbook will be published in 1 week.– First introductory module – mandated for clinical

staff NSW Health - almost ready to go at HETI on-line.

– All modules available by end of December 2014 – Clinician Disclosure and Open Disclosure Advisors

– Roadshow being planned– Expert training proposed early 2015.

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Key Changes to Policy & Process• More patient centred whilst still promoting risk

management approach• Enhanced focus on supporting second victim(s)• Greater scope for reimbursement discussion• Distinction made between Clinician and Formal OD• Introduction of the role of OD Advisors• Guideline replaced by a CEC Handbook • Less reliance on SAC - OD applicable in patient safety

incidents regardless of SAC• Introduction of OD in relation to no harm incidents

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Effective open disclosure includes:• acknowledging to the patient and/or their support person(s)

when things go wrong• listening and responding appropriately when the patient

and/or their support person(s) relate their experiences, concerns and feelings

• the opportunity for the patient and/or their support person(s) to ask questions and to have those questions answered

• providing support for patients and their support person(s) and health care staff to cope with the physical and psychological consequences of what happened.

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Patient Safety Incident

• A patient safety incident is any unplanned or unintended event or circumstance which could have resulted or did result in harm to a patient.

• This includes harm from an outcome of an illness or its treatment that did not meet the patient’s or the clinician’s expectation for improvement or cure.

• Additionally, open disclosure is recommended when the patient has been harmed from a risk inherent to the investigation and treatment of their medical condition

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An incident may have been caused:

• because something has gone wrong during the patient’s episode of care –

• because the outcome of the patient’s illness or its treatment did not meet the patient’s or his/her doctor’s expectation for improvement or cure

• from a recognised risk inherent to an investigation or treatment

• because the patient did not receive his/her planned or expected treatment

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The five essential elements of open disclosure are:

1. an apology “I’m sorry” or “We are sorry”2. a factual explanation of what happened3. an opportunity for the patient to relate his or her

experience4. a discussion of the potential consequences5. an explanation of the steps being taken to manage

the event and prevent recurrence.

Apology

• Defined in the Act as:– “an expression of sympathy or regret, or of a

general sense of benevolence or compassion, in connection with any matter, whether or not the apology admits or implies an admission of fault in connection with the matter

– An apology doesn’t constitute an admission of liability, will not be relevant to the determination of fault or liability in connection with civil liability proceedings and cannot be adduced into evidence

Civil Liability Act 2002

• Full statutory protection • First jurisdiction in world to implement legal

protection for a full apology – that is, one that includes an admission of fault or liability – made by any member of the community

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• There should always be an early meeting between patient/family and treating clinician

• This occurs close to the event and is referred to as Clinician Disclosure

• Any clinician may be responsible - and should therefore need the skills - for leading this type of discussion

Clinician Disclosure

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Clinician Disclosure• Informal process where the treating clinician

(and/or senior clinician or line manager) provides information and apologises

• Process may stop there or be linked to ongoing communication and/or Formal Disclosure.

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Formal Open Disclosure• Structured process that may follow on from clinician

disclosure

• Requires planning and preparation

• Involves the appointment of a co-ordinator, an Advisor and an Open Disclosure team

• May occur over multiple meetings

• Will usually include the sharing of investigation outcomes

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Open Disclosure Advisors

OD Advisors are senior health professionals who have received intensive training in empathic communication skills and are available to support the process within their facility – an impartial third party who facilitates the formal OD meeting with family and/or patient

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Open Disclosure AdvisorsHave a key communication and reporting role

– Member of OD Team– Lead the OD Team planning with clinician– Participate in the Disclosure– Debrief with clinician– Hand over commitments, made during disclosure, to the

facility executive

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Skills Development• Expert Advisors – 2 day workshop proposed.

Focus on simulation with actors. Covers skills for coaching colleagues

• Ongoing revision of skills – 1 day / year

• Debrief programme seen as key element of success

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Practical Support• Clinical Governance• Persons responsible for insurable risk• CEC• Professional Indemnity Insurers

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The CEC Open Disclosure Handbook

1 INTRODUCTION2 WHAT IS A PATIENT SAFETY INCIDENT?3 WHAT IS OPEN DISCLOSURE?4 CLINICIAN DISCLOSURE5 FORMAL OPEN DISCLOSURE6 APOLOGISING AND SAYING SORRY7 PRACTICALITIES OF OPEN DISCLOSURE8 SUPPORT FOR STAFF9 OPEN DISCLOSURE IN SPECIFIC CIRCUMSTANCES

10 FREQUENTLY ASKED LEGAL AND INSURANCE QUESTIONS11 KEY DEFINITIONS AND REFERENCES12 RESOURCES

Available from the Open Disclosure page on the CEC websitehttp://www.cec.health.nsw.gov.au/programs/open-disclosureLimited hard copies will be available.

Reimbursement of Expenses

• PD2014_028 supports an early offer of, and approval for, reimbursement for reasonable out-of-pocket expenses incurred as a direct result of a patient safety incident.

• Practical support such as the above, sends a strong signal of sincerity, and may be raised at a formal open disclosure discussion, if not already discussed during clinician disclosure.

• It is generally accepted that the practical support offered through reimbursement does not imply responsibility or liability.

• Reasonable out-of-pocket expenses may include, but are not limited to, accommodation, meals, travel and childcare.

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Thank you

QuestionsFor further information:

Maree Bellamyt: 9269 5565

e: maree.bellamy@health.nsw.gov.auCEC-OpenDisclosure@health.nsw.gov.au

http://www.cec.health.nsw.gov.au/programs/open-disclosure