Standards for general practices

Quality improvement module

Criterion QI3.2 – Open disclosure

        1. Criterion QI3.2 – Open disclosure

Indicator


QI3.2 A Our practice follows an open disclosure process that is based on the Australian open disclosure framework.

Why this is important

Open disclosure is defined in the Australian open disclosure framework as, ‘an open discussion with a patient about one or more incidents that resulted in harm to the patient while they were receiving healthcare’.

The RACGP has endorsed the Australian open disclosure framework, developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC).

Implementing the Australian open disclosure framework in small practices (as opposed to hospitals) is available at www.safetyandquality.gov.au/publications/implementing-the-australianopen-disclosure-framework-in-small-practices Health professionals have an obligation to:

  • respectfully explain to patients when things go wrong
  • offer an expression of regret or genuine apology (if warranted)
  • explain what steps have been taken to ensure that the mistake is not repeated.

Communicating openly and honestly following adverse events is a way of showing compassion towards patients, and can improve clinician/patient relationships and allow patients to be more engaged in their own care.

Meeting this Criterion

The Australian open disclosure framework states that open disclosure includes:

  • acknowledgement to the patient that something has gone wrong, either in response to their enquiry or initiated by the practice
  • an apology or expression of regret (including the word ‘sorry’)
  • a factual explanation of what happened
  • an opportunity for the patient to share their experience with the practice
  • an explanation of the steps being taken to manage the event and prevent a recurrence.

Open disclosure is a discussion and exchange of information that may take place over several meetings. To meet this Criterion, team members need to listen to what the patient says in response to the practice’s open disclosure and demonstrate that the practice has learnt from the incident. Incidents and near misses can be recorded in the patient’s record as per the Australian open disclosure framework.

Disclosure to the patient following an incident that caused harm is beneficial to both the patient and the practice. Disclosure may also be appropriate where no harm appears to have been caused, especially if there is reasonable likelihood of harm resulting in the future as a result of the incident.

Contact your medical defence organisation and insurers for further guidance and advice about when you may need to participate in open disclosure, and what kind of documentation they would require for risk management initiatives.

Meeting each Indicator

QI3.2 A Our practice follows an open disclosure process that is based on the Australian open disclosure framework.

You could:

  • maintain an open disclosure process and encourage all members of the practice team to follow the process
  • develop and implement policies and guidelines that align with the Australian open disclosure framework
  • keep a record of any discussions and apologies
  • implement quality improvement initiatives (eg develop a brochure to give patients more information about a particular issue)
  • record any incidents in the patient’s record
  • educate practitioners about the Australian open disclosure framework for small practices so that they understand when they might need to undertake open disclosure
  • discuss open disclosure at practice team meetings

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