Being open Communicating with patients and carers after patient safety incidents

What is Being open? Being open involves apologising and explaining what happened to patients who have been harmed as a result of a patient safety incident. It encompasses communications between healthcare professionals, patients and their carers.

Why Being open?  It’s what patients want.  It is ethically and morally the right thing to do.  It reduces litigation costs.  A vehicle for winning back patient confidence.

What’s going on elsewhere?  Australian Open Disclosure Project  JCAHO standards  US National Patient Safety Foundation  Kaiser Permanente and VA hospitals  Academic research studies

The Australian open disclosure project The project found that patients wanted:  to be told about patient safety incidents which affect them;  acknowledgement of the distress that they suffered;  a sincere and compassionate statement of regret;  a factual explanation of what happened;  a clear plan about what can be done medically to redress or repair the harm done.

Being open: ‘Sorry Works!’ ‘Sorry Works!’ is the US Being open programme - it found:  that it removes anger and actually reduces the chances of litigation and costly defence litigation bills;  that it worked successfully in organisations like the University of Michigan Hospital system, Stanford Medical Center, Children's Hospitals and Clinics of Minnesota, and the VA Hospital in Lexington, Kentucky.

Making amends  34% want an apology or explanation;  23% want an inquiry into the causes;  17% want support to cope with the consequences;  11% want financial compensation;  6% want disciplinary action. DH survey interviewed 8,000 members of the public:

Duty of candour “If a patient under your care has suffered serious harm, through misadventure or any other reason, you should act immediately to put it right, if possible. You should explain fully to the patient what has happened and the likely short and long term effects. When appropriate you should offer an apology.” GMC, Good Medical Practice Guide, 2001 Making Amends and General Medical Council emphasise the importance of a duty of candour:

Being open and litigation “It seems to us that it is both natural and desirable for those involved in treatment which produces an adverse result, for whatever reason, to sympathise with the patient and the patient’s relatives and to express sorrow and regret at the outcome. Such expressions of regret would not normally constitute an admission of liability, either in part or full, and it is not our policy to prohibit them, or to dispute any payment, under any scheme, solely on the grounds of such an expression of regret.” NHSLA, 2002 NHSLA and Welsh Risk Pool support openness and honesty with patients:

Being open toolkit  Policy and safer practice notice: owhat to say, who should say it and when;  Video based training programme: ocase studies to demonstrate communicating about incidents ogroups of 16 – using actors to role play scenarios  E-learning: oto be available on in November 2005

 If the apology does not come early the patient/family may be more angry.  An apology is better than an expression of sympathy.  Being prepared is essential.  It’s easy to get caught up in explaining the process and not answering the family’s questions.  The language you use may be meaningless to the patient and/or family.  Don’t inadvertently attribute blame. Learning points

Actions for healthcare organisations  Develop and implement a local Being open policy by June  Identify local Being open leads and clinicians to attend Being open training workshops.  Raise awareness of the Being open e-learning locally and ensure staff have access to it.

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