Open disclosure – frequently asked questions

Every day thousands of people receive health care. Sometimes things go wrong which cause unintentional harm to you or someone you care for. In health care, this is known as an incident. Your healthcare provider (such as a doctor or nurse) should talk with you about it as soon as possible.

Open disclosure is the discussion with you, your healthcare provider and the people you may choose to support you (such as your family, carer or friend) about an incident that caused harm whilst receiving health care.

Open disclosure includes:

• Apologising to you for what went wrong
• Explaining the known facts
• Listening to your experience
• Explaining how it may affect you and your care
• Explaining the steps being taken to prevent it happening again.

Open disclosure can take place over one or more discussions.

The Australian Charter of Healthcare Rights explains your rights during open disclosure.

This includes the right to:

• Be told what went wrong with your health care, how it happened, how it may affect you, what is being done to make your care safe
• Share your experience and participate to improve the quality of care and health services
• Ask questions and be involved in open and honest communication
• Provide feedback or make a complaint without it affecting the way you are treated.

It is the responsibility of the health service to start the open disclosure process. However, if you think you have been harmed, you can talk with your healthcare provider or the health service manager. Some health services have a patient representative or advocate you can talk to.

Some things you can say to start the process are:

• I feel that something has gone wrong with my care and I was harmed. Is there someone I can talk to about it?
• I wasn’t expecting this to happen. I would like to talk to someone about my concerns.
• Can I have more information about your open disclosure process and who to contact?

You have the right to access the support you need during open disclosure. This may include:

• Translators
• Interpreters
• Indigenous Liaison Officers
• Counsellors
• Trained patient support people such as consumer representatives, peer workers, social workers or advocates
• Payment of out-of-pocket expenses for things such as transport, meals, or parking.

The timing of the open disclosure discussions should be decided in consultation with you. The initial discussion should occur as soon as possible (if practical, within 48 hours) after the incident. Sometimes it can take a longer to arrange a time that is suitable for everyone.

It may be helpful to write down:

• Your timeline of events
• Your questions and concerns in relation to:
  • what went wrong
  • how it happened
  • how it may affect you and your care
• Anything else you would like to talk about during the open disclosure discussion.

Some other things to think about are:

• Who you would like with you for support during the discussions
• How the health service can help meet your needs
• If you would like to have a second opinion about your health care.

You can bring your support people to the discussions. You can also ask that your GP be invited.

Open disclosure discussions are usually attended by your healthcare provider and health service senior management. Some health services will have at least one person who will go to every discussion. Often this person is the Practice or Service Manager, or a senior doctor. Other health services will have a senior representative with knowledge of the incident attend each discussion (although it may not always be the same person). You can discuss with your health service whom you would like to attend the discussions.

The location of the open disclosure discussions should be decided in consultation with you. Often, the discussions will take place face to face in a private area of the health service. Discussions can also take place via phone or videoconference where appropriate.

Incident investigations refer to processes health services undertake to look into how an incident occurred. Open disclosure discussions can help provide insights and information about an incident. This information can support the investigation process.

The complaints process is a separate process to open disclosure. If the open disclosure process does not meet your needs you can:

• Discuss your concerns with your healthcare provider or health service senior management such as the Practice Manager or Service Manager
• Make a complaint through the health service feedback and complaints system. Some health services will have a complaints officer you can talk to
• Contact your state or territory health care complaints agency or health department if you feel unable to talk to your health service, or if you are not satisfied with their response
• Talk to a lawyer about the harm you experienced.

Your healthcare rights – Key contacts

The Australian Open Disclosure Framework was released in 2013 by the Australian Commission on Safety and Quality in Health Care. It provides a framework for clear and consistent communication by healthcare providers when an incident occurs and a person experiences unintentional harm. It includes guidance on apologising, discussing what happened, why it occurred, and what is being done to prevent it happening again.

It was developed with input from consumers, healthcare providers, indemnity insurers, health departments and health service organisations from across Australia.

It was developed to:

• Provide a nationally consistent basis for open disclosure discussions in Australia
• Provide an outline of the key elements of open disclosure
• Support healthcare providers and health services implement and practise open disclosure
• Encourages open and honest communication between you and your healthcare providers
• Help facilitate resolution for you, your support people and healthcare providers involved
• Support system learning and improvements so that the causes of incidents can be understood and changes made to minimise the risk of it happening again.

It is intended for use by all Australian health services. Health services and healthcare providers in rural areas, the sub-acute sector, primary and community-based care, mental health, and small practices are encouraged to adapt it to suit their context.

Open disclosure is an accreditation requirement of health services accredited under the NSQHS Standards. These Standards provide a clear statement about the level of care consumers can expect. The NSQHS Standard: Clinical Governance, Action 1.12, requires health services to use an open disclosure program that is consistent with the Framework; and monitor and act to improve the effectiveness of open disclosure processes.

More information on the NSQHS Standards and accreditation

• Consumer and carer open disclosure resources
• Clinician/healthcare provider open disclosure resources
• Health service manager open disclosure resources