Patients' and family members' experiences of open disclosure following adverse events

University of Technology Sydney, Australia.
International Journal for Quality in Health Care (Impact Factor: 1.76). 10/2008; 20(6):421-32. DOI: 10.1093/intqhc/mzn043
Source: PubMed


To explore patients' and family members' perceptions of Open Disclosure of adverse events that occurred during their health care.
We interviewed 23 people involved in adverse events and incident disclosure using a semi-structured, open-ended guide. We analyzed transcripts using thematic discourse analysis.
Four States in Australia: New South Wales, Victoria, Queensland and South Australia.
Twenty-three participants were recruited as part of an evaluation of the Australian Open Disclosure pilot commissioned by the Australian Commission on Safety and Quality in Health Care.
All participants (except one) appreciated the opportunity to meet with staff and have the adverse event explained to them. Their accounts also reveal a number of concerns about how Open Disclosure is enacted: disclosure not occurring promptly or too informally; disclosure not being adequately followed up with tangible support or change in practice; staff not offering an apology, and disclosure not providing opportunities for consumers to meet with the staff originally involved in the adverse event.
of participants' accounts suggests that a combination of formal Open Disclosure, a full apology, and an offer of tangible support has a higher chance of gaining consumer satisfaction than if one or more of these components is absent.
Staff need to become more attuned in their disclosure communication to the victim s perceptions and experience of adverse events, to offer an appropriate apology, to support victims long-term as well as short-term, and to consider using consumers' insights into adverse events for the purpose of service improvement.

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    • "When patients and families register concerns, their actions often are perceived as adversarial threats or unscientific anecdotes that lack evidence, rather than potential knowledge contributions . Although there are notable exceptions, at the policymaking level user participation tends to be marginalised too, often by well meaning leaders who assume patients and families are unable to appreciate the complexity of healthcare (Iedema et al. 2008, 2011). Such an approach fails to take into account that many users offer the richest resource of information related to medical errors as many have witnessed every detail of system failures from the beginning to end. "
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    • "Furthermore, a number of studies have now shown that inadequate communication itself may cause communication failures, and that these failures have real consequences for patients' health: they harm patients (Iedema et al., 2008). Much of this communication harm has been shown to be avoidable. "

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    • "are untoward incidents, therapeutic misadventures, iatrogenic injuries, or other adverse occurrences directly associated with care or services provided within the jurisdiction of the medical centre, outpatient clinic, or other [health care] facility " (VHa Policy, cited in Cantor et al., 2005, p. 6). 2. It remains unclear from the COPIC materials, however, whether it is the admission of liability and settlement or the grief management, or both, that lead to the positive results reported to flow forth from Open Disclosure. 3. This article is part of a series of articles that reports on the national evaluation of Open Disclosure practices in australia (see References and Iedema et al., 2008b; Iedema, Sorensen, & Piper, 2008; Sorensen, Iedema, Piper, Manias, & Tuckett, in press). The research was funded by the australian Commission on Safety and Quality in Health Care (aCSQHC) and was managed by Queensland Health. "
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    ABSTRACT: This article presents an inquiry into how clinicians realize a health policy reform initiative called Open Disclosure. Open Disclosure mandates that discussions with patients/family and team staff about “adverse events” are now no longer ad hoc, individualized, and without consequences for how the work is done, but planned, collaborative, and leading to systems change. The article presents an empirical analysis of a corpus of interviews about the impact of Open Disclosure on clinicians' practices. It situates Open Disclosure in the context of arguments that health care workers are increasingly expected to do “emotional labor” with patients and their families, in that staff are advised to practise “reflexive listening” as a means of managing patients' and family members' emotions in response to incidents. The analysis suggests that thanks to the intensity of Open Disclosure interactions, clinicians may be introduced to an affective-interactive space that they were hitherto unaware of and unable to enter or attain what Nigel Thrift calls “a new structure of attention.”
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