Open disclosure information for staff

Effective patient incident management and open disclosure processes are attributes of high-quality health service organisations, and important parts of quality improvement and consumer- or patient-centred approach to healthcare.

Open disclosure is the process of providing an open, consistent approach to communicating with patients/consumers, their family, carer and/or support person (consumers) following an incident. This process includes expressing regret or saying sorry.

Consumers should be supported, cared for and provided with information in every step of the open disclosure process.

  • Consumers can contribute to the investigation, and may make suggestions during open disclosure which contribute to improving the safety and quality of care.
  • it is important that consumers are informed of the recommendations arising and actions taken or planned to prevent recurrence and improve safety and quality of the service

Doing these things can assist affected consumers to recover from the incident and restore their confidence in their health care.

SA Health resources

The Patient Incident Management and Open Disclosure Policy Directive (PDF 1.9MB) describes a standardised system for managing patient incidents and open disclosure processes. This includes regular review of the open disclosure processes, and patient experience of incidents.

Open Disclosure Toolkit

The policy directive has a toolkit that has been developed to assist staff to conduct, or participate in an open disclosure process for level 1 (SAC 1 and 2) and level 2 (SAC 3 and 4) incidents.

Consumer information and resources are available on the Open disclosure information for consumers page.

Tool 1 – Quick guide to the open disclosure process

Tool 1 – Quick guide to the open disclosure process (PDF 161KB) provides information on the level 1 (SAC 1 and 2) and level 2 (SAC 3 and 4) responses to open disclosure and the process.

Tool 2 – Saying sorry – A guide to expressing regret during open disclosure

Tool 2 – Saying sorry – A guide to expressing regret during open disclosure (PDF 142KB) provides staff with information and examples on appropriate wording and phrasing for the open disclosure process, as an expression of regret.

Tool 3 – Comprehensive guide on open disclosure for clinical leads / facilitators

Tool 3 – Comprehensive guide on open disclosure for clinical leads / facilitators (PDF 256KB) is a comprehensive guide for clinical leads / facilitators with more detailed information on the formal open disclosure process, and tools.

Tool 4 – Open disclosure Patients / Consumers brochure

Tool 4 – Open disclosure Patients / Consumers brochure (PDF 104KB) on the open disclosure process.It outlines what is open disclosure, when should open disclosure occur, what the benefit of open disclosure is, and where to obtain additional information.

Tool 5 – A guide for patients/consumers beginning an open disclosure process

The Tool 5 – A guide for patients/consumers beginning an open disclosure process (PDF 142KB) is designed to help patients, consumers, families, carers and/or support person when an incident resulting in harm has occurred.The guide talks about health services (including hospitals), outlines what an incident is, what the open disclosure process is, what they can expect from the process, including how to prepare for the first open disclosure meeting.

Tool 6 - Open disclosure flowchart for patients/consumers – incident resulting in harm and near miss / no harm

Tool 6 - Open disclosure flowchart for patients/consumers – incident resulting in harm and near miss / no harm (PDF 65KB) illustrates the steps in the reporting and management of an incident resulting in harm, and a near miss incident for patient/consumers, their families, carers and/or support persons.

Tool 7 – Frequently asked questions about Open Disclosure for patients/consumers, families, carers and/or support persons

Tool 7 – Frequently asked questions about Open Disclosure for patients/consumers, families, carers and/or support persons. (PDF 63KB) provides patients/consumers, their families, carers and/or support persons with frequently asked questions about the open disclosure process, including what is open disclosure, what to expect in the process, what is an incident, what you can do, and how to find out more information on open disclosure.

Tool 8 – Safety Learning System (SLS) topic guide for open disclosure

Tool 8 – Safety Learning System (SLS) topic guide for open disclosure (PDF 90KB) will assist managers and Open disclosure facilitators to record in Safety Learning System (SLS) the Level 1 or 2 Open disclosure process that occurs in response to a patient incident.

Tool 9 – Open disclosure process checklist

Tool 9 – Open disclosure process checklist (PDF 92KB) is a tool to assist staff in the open disclosure process.It outlines key activities to be completed as part of the open disclosure process.

Tool 10 – Patient considerations

Tool 10 – Patient considerations (PDF 114KB) provides staff with information on what to consider when communicating with patients, including the patient needs for children, mental health conditions, culturally and linguistically diverse, aboriginal and torres strait islander, hearing or vision impaired, people with a disability; cognitive impairment.Information on the importance of communicating early, advocacy and support requirements, reimbursement, and ongoing care, and other considerations.It also outlines the patient/consumer resources available, refers to the saying sorry guide, and patient evaluation process of the open disclosure process.

Tool 11 – Staff considerations

Tool 11 – Staff considerations (PDF 82KB) provides staff with information on key considerations such as providing advice and training on incidents, communication skills, and the need for support. It outlines the staff rights and responsibilities, use of substitute clinicians, and assistance with initial open disclosure discussions.It also provides staff with information on legal counsel, what junior clinicians can benefit in observing and participating in open disclosure.

Tool 12 – Open disclosure meeting checklist

Tool 12 – Open disclosure meeting checklist (PDF 80KB) is a tool to assist staff in the open disclosure process for beginning the meeting, what to do during the meeting ie explaining the facts, identifying patient's key concerns and expressing regret. It also provides information on closing the discussion and subsequent follow up.

Tool 13 – Open disclosure meeting planning and preparation tool

Tool 13 – Open disclosure meeting planning and preparation tool (PDF 92KB) is designed to assist in planning for the first open disclosure meeting, and provides a guide on the information to source for the meeting.

Tool 14 – Documentation and discussion summary

Tool 14 – Documentation and discussion summary (PDF 83KB) is to be completed with the patient/consumer, their family, carer and/or support person.The summary provides a brief factual summary of incident, staff member who led the open disclosure discussions, summary of all points explained and plans for follow up.

Tool 15 – Patient/consumer, family, carer and/or support person evaluation survey

Tool 15 – Patient/consumer, family, carer and/or support person evaluation survey (PDF 156KB) has been developed to enable feedback from patients/consumers, their families, their carers and/or support person about the open disclosure process. The aim of the survey is to improve the open disclosure experience for people involved in an incident that resulted in harm to a patient while receiving health care.

Tool 16 – Staff evaluation survey

Tool 16 – Staff evaluation survey (PDF 152KB) has been developed to enable feedback from staff about the open disclosure process. The aim of this survey is to improve the open disclosure experience for people involved in an incident that resulted in harm to a patient while receiving health care.

Tool 17 – Level 1 Open disclosure response flow chart

Tool 17 – Level 1 Open disclosure response flow chart (PDF 72KB) illustrates the steps in the reporting and management of an incident resulting in harm for level 1 (SAC 1 or SAC 2) open disclosure response.

Tool 18 – Level 2 Open disclosure response flow chart

Tool 18 – Level 2 Open disclosure response flow chart (PDF 73KB) steps in the reporting and management of a near miss for level 2 (SAC 3 or SAC 4) open disclosure response.

Education and training

It is expected that all staff will complete the online eLearning course on Patient Incident Management and open disclosure (available on the SA Health intranet Safety and Quality website) and use the resources in the open disclosure toolkit to guide the conduct of, and participation in, open disclosure.

There are 2 levels of Open Disclosure process.

  • Incidents that are rated SAC 1 or SAC 2 require a Level 1 process. This includes the participation of a senior member of the clinical team, and also a staff member who has undergone Open Disclosure Facilitator training. For further information about this training contact local Safety and Quality Manager.
  • Level 2 is for SAC 3 and SAC 4 rated incidents.

Safety Learning System (SLS) and Open Disclosure

Use SLS to record that Open Disclosure has occurred. The SLS Topic Guide Tool 8 – Safety Learning System (SLS) topic guide for open disclosure (PDF 90KB) assist managers and Open disclosure facilitators to record in Safety Learning System (SLS) the Level 1 or 2 Open disclosure process that occurs in response to a patient incident.

For more information on for reporting and managing patient incidents using the SLS see the Patient incident management in Safety Learning System page.

Contact

Clinical Governance Unit
Telephone: (08) 8226 6334