1. Scope
All MAS employees and contractors who provide health services on behalf of MAS will comply with this policy.
2. Purpose
MAS acknowledges that effective incident management and open disclosure processes are attributes of delivering a high-quality patient centered service and are an important part of quality assurance processes.
Open disclosure is the process of providing an open, consistent approach to communicating with patients and/or their support person(s) and clients following an incident. This process includes expressing regret and saying “sorry”.
This policy outlines a standardised system for managing patient incidents that ensures all MAS staff:
- Use the MAS Incident Management Policy for reporting and documenting the management and open disclosure of patient incidents.
- Provide appropriate feedback to, and engage with patients, their support person(s) and clients.
- Respond effectively to patient incidents.
- Promote safety and quality improvements through sharing lessons learnt from patient incidents.
- Take action in collaboration with the Clinics to improve the safety and quality of the MAS services.
- Maintain compliance with relevant laws and codes of conduct in relation to transparent and fair treatment, privacy and confidentiality of both patient and staff.
This policy is to be used in conjunction with the MAS Incident Management Policy.
3. Principles
The following principles of open disclosure are based on the Australian Open Disclosure Framework1.
3.1 Openness and timeliness of communication
If care does not go to plan, the patient, support person(s) and the clinic will be provided with information about what happened in an open, honest and timely manner. The open disclosure process is fluid and may involve provision of ongoing information.
3.2 Acknowledgement
All adverse events will be acknowledged to the patient, their support person(s) and the clinic as soon as practicable.
3.3 Apology or expression of regret
As early as possible, the patient and their support person(s) will receive an expression of regret for any harm that resulted from the adverse event. The expression of regret should include the words “I am sorry / We are sorry”, but must not contain speculative statements, admission of liability or apportioning of blame.
3.4 Recognition of the reasonable expectation of patients and their support person(s)
The patient and their support person(s) may expect to be fully informed of the facts surrounding an adverse event and its consequences, be treated with empathy, respect, consideration and be supported in a manner appropriate to their needs.
3.5 Staff support
MAS endorses and encourages an environment in which all staff are able to recognise and report adverse events and are supported through the open disclosure process.
3.6 Integrated risk management and system improvement
Adverse event investigations will be conducted via the MAS Incident Management Policy to manage the associated risks. Outcomes of the investigations will be used to focus on improving MAS processes and will be reviewed for their effectiveness.
3.7 Good governance
To prevent recurrence, the MAS Leadership team will ensure these changes are implemented and their effectiveness reviewed.
3.8 Confidentiality
MAS have policies and procedures in place with full consideration of consumer and staff privacy and confidentiality, and in compliance with relevant laws, including the Commonwealth and state or territory privacy and health records legislation.
4. Responsibilities
All staff are responsible to recognise that a patient has suffered unintended harm during their care with MAS.
4.1 General Manager
- Is accountable for establishing open information exchange with the patient and their support person(s), MAS staff and contractors, clinics and insurance companies in relation to issues of clinical error.
- Ensures all MAS staff are clear about their roles regarding this policy.
- Works closely with the Medical Advisor(s) and the Director of Nursing in investigating, reviewing, analysing and reporting of the incident as per this policy, the MAS Incident Management policy and the MAS By-laws.
- Reports all events and initiation of the MAS Open Disclosure Policy to the MAS Director.
4.2 Medical Advisor(s)
- Are responsible for supporting the treating Consultant Anaesthetists in implementing this policy.
4.3 Director of Nursing
- Is responsible for supporting the MAS staff to implement this policy.
- Has operational responsibility for the coordination of this policy.
4.4 Employees
- Are responsible for understanding and implementing this policy.
4.5 Patients and their support person(s)
- Are responsible for actively participating in the care and treatment they are receiving.
- Informing staff when they are dissatisfied or concerned about the safety of care or service provided.
4.6 Clinics
- Informing MAS Leadership team when they are dissatisfied or concerned about the service MAS staff are providing.
5. Processes
As soon as an adverse event causing harm is identified, the initial response must be the prompt and appropriate clinical care and prevention of further harm.
5.1 Criteria for determining the level of response
The level of harm sustained by the patient will determine the level of response.
| Criteria | |
| Lower-level response | · Near misses and no-harm incidents. · No permanent injury. · No increased level of care required. · No, or minor, psychological or emotional distress |
| Higher-level response | · Death or major permanent loss of function. · Permanent or considerable lessening of body function. · Significant escalation of care or major change in clinical management (e.g. transfer to hospital). · Major psychological or emotional distress. · At the request of the patient or their support person(s). |
5.2 Key elements
The below are the key elements of open disclosure.
5.2.1 Incident detection
Incidents can be detected through a variety of mechanisms such as:
- At the time of the incident by MAS staff, patient, patient support(s) or clinic staff.
- Retrospectively when an unexpected outcome is detected by MAS staff, patient, patient support(s) or clinic staff.
- Established MAS feedback mechanisms.
- MAS Incident reporting.
- Other sources such as other visitors or staff.
5.2.2 Actions to take after an incident occurs
After an incident occurs:
- Provide prompt and appropriate clinical care to prevent further harm.
- Assess the incident’s severity and level of response required.
- Provide support to staff involved.
- Escalate to the MAS Leadership team.
- Ensure privacy and confidentiality of all parties involved.
- Submit an MR12 – Incident report as soon as it is appropriate.
- Document the incident in the MR11 – Progress notes.
Note – the above criteria apply in the event of medication errors.
5.2.3 Signaling the need for open disclosure
- Acknowledge the incident to the patient, support person(s) and the clinic.
- Note any comments and observations by the affected parties and answer questions they may have.
Note – a lower-level response can conclude at this stage.
- Signal the need for open disclosure.
- Negotiate with the patient, their support person(s) or nominated contact person:
- The formality of open disclosure required.
- The time and place for open disclosure.
- Who should participate during the open disclosure.
- Provide written confirmation.
- Provide the MAS DON contact for the patient, their support person(s).
- Avoid speculation and blame.
- Maintain good verbal and written communication.
5.2.4 Preparing for open disclosure
- Hold a team discussion to prepare for open disclosure.
- Determine who will participate in open disclosure.
- Appoint a team member to lead the open disclosure based on previous discussions with the patient and support person(s).
- Gather all the necessary information.
- Use the https://www.health.vic.gov.au/sites/default/files/migrated/files/collections/research-and-reports/o/open-dislosure-checklist-and-plan-v02—doc.doc to assist in preparing.
5.2.5 Engaging in open disclosure
- Provide the patient and support person(s) the names and roles of all attending team members.
- Provide a sincere and unprompted apology or expression of regret including the words “I am / we are sorry”.
- Clearly explain the incident.
- Give the patient and support person(s) the opportunity to tell their story.
- Encourage the patient and support person(s) to describe the personal effects of the adverse event.
- Agree on, record and sign the open disclosure plan.
- Assure the patient and support person(s) that they will be kept informed of further investigation findings and recommendations for process improvements.
- Offer practical and emotional support to the patient, support person(s) and staff involved.
- If necessary, agree to more meetings until these aims are achieved.
5.2.6 Providing follow-up
- Ensure follow-up by the MAS Leadership team (where appropriate).
- Agree on future care (if required).
- Share the findings of investigations and the resulting process changes.
- Offer the patient and support person(s) to discuss the process with another clinician.
5.2.7 Completing the process
- Assure the patient and support person(s) that further information and follow-up care will be provided.
- Maintain contact if the investigation is ongoing and share outcomes and process changes.
- Provide a final written and verbal communication to the patient and support person(s).
- Communicate any relevant information to other relevant MAS staff.
- Complete evaluation surveys.
5.2.8 Maintaining documentation
- Keep the patient record up to date.
- Maintain a record of the open disclosure process.
- File documents in the patient record.
- Provide the patient with documentation throughout the process.
6. References
Australian Open Disclosure Framework
Australian Open Disclosure Framework (Australian Commission on Safety and Quality in Health Care (2013) Implementing the Australian Open Disclosure Framework in small practices. ACSQHC, Sydney.
Victorian Government Department of Health. (2008), Open disclosure for Victorian health services: A guidebook.
https://www.health.vic.gov.au/quality-safety-service/open-disclosure-framework