Ann Duffy, Senior Clinical Risk Manager, discusses how Open Disclosure is changing in Ireland and what this means for health and social care professionals.

Patients/service users reasonably expect transparency and place their trust firmly in the hands of the professionals caring for them during their interaction with the healthcare system. Trust can be fragile and tested to the point of collapse when things go wrong and an incident or an outcome is not communicated or expressed clearly, and in a timely manner, by the health or social care professional.

Open Disclosure is not solely about error management. It is also relevant to patient/service user outcomes which may not have been expected but are not necessarily an error. When undertaken in an informed, clear and sensitive manner, Open Disclosure assists patients/service users and health and social care professionals to engage proactively about the incident or outcome.

How has Open Disclosure evolved in Ireland?

In 2008, the Commission on Patient Safety and Quality Assurance made a number of recommendations specific to Open Disclosure. Set out below are the key milestones in the development of Open Disclosure in Ireland since then.

Key recent developments

Civil Liability (Amendment) Act, Part 4, 2017:

The Act provides protection for Open Disclosure when undertaken by health and social care professionals. If disclosure is undertaken in accordance with the Act it does not invalidate indemnity or insurance, constitute an admission of liability nor is it admissible in legal proceedings.

Regulations for the Act were introduced in September 2018.

To gain the protective provisions of the Act, prescribed forms must be used during the Open Disclosure process. A ‘statement of information’ must be provided at the initial Open Disclosure meeting. If for any reason the patient/service user cannot attend a meeting, requires additional information, refuses to accept the statement, or requests a clarity meeting, then a separate and specific prescribed form must be completed for each of these particular scenarios.

Training for doctors:

The HSE has commissioned the development of a Communications and Open Disclosure training programme for doctors, including current and future legislative requirements for Open Disclosure. The SCA will support the work of the HSE, professional bodies and other stakeholders to develop this programme.

HSE National Open Disclosure Steering Committee & National Open Disclosure Office:

To strengthen corporate oversight, strategic leadership and accountability in the practice of Open Disclosure, the HSE has established a National Open Disclosure Steering Committee.

The committee will provide strategic guidance to the newly established HSE National Open Disclosure Office on the implementation of Open Disclosure taking account of current and upcoming legislation, and the recommendations of the Scally report.

Patient Safety Bill:

The Patient Safety Bill was published in 2018. When enacted, this will introduce mandatory reporting and disclosure of a prescribed list of serious patient safety incidents. The legislation will contain sanctions for failure to disclose such incidents.

So what does it mean for frontline staff?

• Health and social care professionals need to be aware of the requirements to engage in Open Disclosure when things go wrong or unexpected outcomes occur in the care of their patients or service users
• To avail of legal protections, Open Disclosure must be undertaken using the forms set out in the regulations as prescribed by the Civil Liability (Amendment) Act 2017
• Mandatory Open Disclosure of certain serious patient safety events is likely to be a legal requirement in the near future

Challenging times

The evolution of Open Disclosure in Ireland in recent years presents challenges for all those providing health and social care services. Practical support and education are required to assist health and social care professionals, and in particular the medical profession, to comply with the legislation. Transparency and disclosure are now expected more than ever before by patients and service users.

All health and social care professionals need to respond to the challenge by engaging with Open Disclosure as part of an on-going process of open, clear and honest communication between health and social care providers and patients/service users.

References available on request.