Enacting open disclosure in the UK National Health Service: A qualitative exploration.

Reema Harrison,Yvonne Birks,Kate Bosanquet,Rick Iedema

doi:10.1111/jep.12702

Reema Harrison, Yvonne Birks + Show 2 more

Open Access

https://doi.org/10.1111/jep.12702

Copy DOI

Abstract

Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure. Semistructured interviews with 13 doctors and 22 nurses from a range of levels and specialities from 5 national health service hospitals and primary care trusts in the UK were conducted and analysed using a framework approach. Five themes were identified which appear to capture the factors that are critical in supporting open disclosure: open disclosure as a moral and professional duty, positive past experiences, perceptions of reduced litigation, role models and guidance, and clarity. Greater openness in relation to adverse events requires health professionals to recognise candour as a professional and moral duty, exemplified in the behaviour of senior clinicians and that seems more likely to occur in a nonpunitive, learning environment. Recognising incident disclosure as part of ongoing respectful and open communication with patients throughout their care is critical.

Highlights

Open and honest discussion between healthcare providers and the patients and families affected by adverse patient safety events is considered to be a central feature of high quality and safer patient care.[1,2,3]
Recent high profile cases, such as the events occurring at the Mid‐Staffordshire Hospital Trust in the UK demonstrate that the practice of open disclosure continues to fall short of patient and family expectations.[6]
A health service culture of secrecy, lack of confidence amongst health professionals, fear of exacerbating patient's distress, and doubts regarding the effectiveness of open disclosure in meeting patients' needs relating to adverse events (AEs) are identified in the literature as the main reasons for nondisclosure.[7]

Summary

Introduction

Despite policy advancement and implementation around open disclosure, as few as 30% of harmful events may currently be disclosed to patients.[5] Recent high profile cases, such as the events occurring at the Mid‐Staffordshire Hospital Trust in the UK demonstrate that the practice of open disclosure continues to fall short of patient and family expectations.[6] Fears of litigation, a health service culture of secrecy, lack of confidence amongst health professionals, fear of exacerbating patient's distress, and doubts regarding the effectiveness of open disclosure in meeting patients' needs relating to adverse events (AEs) are identified in the literature as the main reasons for nondisclosure.[7]. Open and honest discussion between healthcare providers and patients and families affected by error is considered to be a central feature of high quality and safer patient care, evidenced by the implementation of open disclosure policies and guidance internationally. This paper discusses the perceived enablers that UK doctors and nurses report as facilitating the enactment of open disclosure

Objectives

Discussion

Conclusion