Open Disclosure
Policy
The National Adverse Events Policy 2023takes a restorative approach to open disclosure, aiming to understand the patient's experience of harm and restore the relationship.
RNZCGP advise that general practices should remain on the 2017 National Adverse Events Policy at this stage, rather than transitioning to the new 2023 National Adverse Events Policy. RNZCGP are still working with HQSC to identify how the new national policy will apply to general practice.
We use 
open disclosure to communicate with patients and their whānau when harm or potential harmhas happened as a result of our care.
Harm is anything negative happening to patients or whānau as a direct result of the provision of health care.
It may be:
- physical – includes injury or reduced ability to care for themselves
- psychological – mental or emotional trauma or that causes behavioural change or physical symptoms
- cultural – marginalisation of the patient's beliefs and values
- spiritual, including spirtual distress – reduction in the ability to find meaning, peace, comfort or strength.
It is important to note that the patient's experience of harm may be different from the clinician's perception of it.
Open disclosure should also be considered in situations of potential harm where the system did not work as intended, even if no harm was experienced.
Source: National Adverse Events Policy 2023
Open disclosure is the timely and transparent approach to communicating with a patient when harm, or potential for harm, has occurred. It offers the opportunity to repair well-being, relationships, and trust.
Open communication should maintain or restore the tapu or dignity of all the people involved.
Source: National Adverse Events Policy 2023
Open disclosure is:
- a patient's right under the Code of Health and Disability Services Consumers' Rights 1996
Rights that apply to open disclosure include:
- Right 1: The right to be treated with respect.
- Right 4: The right to services of an appropriate standard.
- Right 5: The right to effective communication.
- Right 6: The right to be fully informed.
- Right 8: The right to have a support person present.
- Right 10: The right to complain.
Source: HQSC | Te Tāhū Hauora Guidance on Open Disclosure Policies.
- a clinician's professional, ethical, and moral duty.
If a patient experiences harm as a result of our care, we will:
- communicate transparently about what happened
- apologise and acknowledge responsibility
- seek to understand the patient and whānau's experience of harm
- identify any support needed
- explain what is being put in place to prevent the event happening again.
Open disclosure is part of the incident management process. It provides a framework for the communication between the practice and patient about what happened. For the full process, see Managing and Reporting Incidents.
Open disclosure conversations are confidential and we maintain the privacy of those involved:
- Patient information is kept private in accordance with the Health Information Privacy Code 2020.
Staff involved in the event are not identified during discussions with the practice team.
Wherever possible, we focus on improving systems and restoring trust rather than assigning blame.
Clinical governance
All open disclosure conversations are reported to our clinical governance group as part of our incident management process to identify learning opportunities or if quality improvement (CQI) is needed.
Quality improvement (also called continuous quality improvement, or CQI) is a framework for improving health care.
It is the ongoing process of:
- examining issues that arise
- identifying areas for learning and improvement
- implementing changes to systems and processes.
See also Clinical Governance
Making an open disclosure
|
|
|
Step:
|
Action:
|
Event causes harm or potential harm
|
1.
|
As soon as the event is recognised, begin the incident management process.
For the full incident management process, see Managing and Reporting Incidents.
|
Within 24 hours of identifying the event
|
2.
|
Prepare for the initial conversation
The initial conversation must happen as soon as practicable after identification of the event. It should not wait for an investigation.
Consider:
- Is interpreting or translation assistance needed?
- What is needed to support the person's culture, values, or beliefs?
- Who is the most suitable person to talk to the patient?
A senior clinician (preferably the doctor with the lead responsibility for the patient's care) should be the person who communicates with the patient and whānau.
It may be appropriate to include a second person, for example:
- a clinician the patient has a good relationship with
- the clinician the patient has seen most recently
- a senior manager, especially if the event is significant.
- Does the clinical team need to meet to identify what happened and potential consequences for the patient? Be aware that this should not delay the initial conversation.
|
|
3.
|
Have the initial conversation.
If possible, meet face-to-face with the patient, or their representative. Encourage them to bring whānau or a support person.
In some situations, disclosure must be made to a third party:
- If patient has since died, make the disclosure to their next of kin or another appropriate person.
- If patient is too unwell to hear a disclosure, disclose the event to their legal guardian or power of attorney.
Talk to the patient about what has happened:
Explain that you will be in touch again once they have had a chance to process the conversation, and will update them about further developments.
|
|
4.
|
Ensure patient is aware of their options.
Provide them with:
- complaints information
- ACC claim information, if appropriate
- contact details for the local health and disability consumer advocate.
|
Immediately after the conversation
|
5.
|
Document the conversation.
Make full notes and document the open disclosure conversation in the patient record.
Include in the patient record:
- details of the event and any harm caused
- details of disclosure:
- who was present
- what was discussed
- patient's reaction to the disclosure
- any issues with continuity of care.
- actions and timeframes
- any unresolved concerns.
Consider sending a copy of your notes or a follow-up letter so the patient has the information in writing.
|
Over the following weeks/months
|
6.
|
Have further conversations with the patient and whānau as needed.
- Continue conversations until they have all the information and support they need.
- Update them with any additional information discovered after the initial conversation.
- Advise of further actions or outcomes as they become known.
|
|
7.
|
Support staff involved in the event.
- Offer debrief and support to staff involved.
- Focus on identifying opportunities for improvement rather than assigning blame.
See also Stress and Well-being.
|