In this resource :

  • Patient Safety and Incident Management Toolkit

Disclosure 

Disclosure is a formal process involving open discussion between a patient/family and members of a healthcare organization about a patient safety incident (including near misses).Disclosure provides the means for dialogue throughout the incident management process, supports patient safety improvement and promotes healing for the patients/families and providers involved.  

It generally occurs in two broad stages (initial and post-analysis) and is an ongoing process in which multiple disclosure conversations occur over time.  

“…It made me feel that I could trust my provider because, I mean she took responsibility… had remorse about what happened.  She wasn’t defensive.” -- A family member 

 

“I wasn’t allowed to be a part of the disclosure process, I needed to see the family of the boy who died; I needed to say: ‘I’m sorry.’  I’ll always wonder if they know how sorry I am and how it changed my practice.”  -- A healthcare provider 


Recommended Strategies
 

Before an incident 

Confirm that organizational processes support disclosure 

  • Establish guiding principles for disclosure (e.g. patient-centred healthcare, patient autonomy, honesty and transparency, patient safety, just culture, learning and improvement). 
  • Develop disclosure policies, procedures and tools aligned with the organization’s guiding principles, disciplinary/accountability systems, legislation, regulatory/licensing requirements, and best practices that: 
    • involve patients/ families and frontline staff in their development 
    • articulate when and where disclosure should take place and how it should be conducted 
    • include supports and resources available to the patient/family and healthcare providers 
    • provide guidance on how to deal with the media in the event of a public disclosure 
    • incorporate processes that address special circumstances such as multi-patient disclosures, paediatric patients or those with mental health issues, or incidents related to research 
    • are easily accessible to all, including frontline staff and patients/families (e.g. public site) 
    • are updated regularly to ensure relevance and alignment with other policies and current context 
  • Provide disclosure training programs and educational resources for staff and patients/families. 
  • Allocate resources to assist patients/families involved in patient safety incidents, ensuring they are available without delay (e.g. practical, emotional, financial). 
  • Allocate resources to assist staff at the frontline involved in patient safety incidents as needed, including disclosure support and coaching. 

After an incident 

Develop a specific disclosure plan 

  • After caring for the immediate needs of the patient/family and providers, develop a customized disclosure plan specific to the incident and the ongoing needs of those involved. 
  • If possible, conduct a pre-disclosure team huddle to determine the best approach, including: 
    • when the initial disclosure will occur taking into consideration patient/family readiness and preferences 
    • where the disclosure will take place, preferably a private area that is free of interruptions or off-site if indicated 
    • what information will be shared with the patient/family, including confirmation of the known undisputed facts 
    • who is the best person to initiate disclosure and coordinate the ongoing disclosure 
    • how the care providers involved in the incident will be supported 
    • how the patient/family will be supported and their questions/concerns addressed 
    • how disclosure will be documented 
  • Inquire with the patient/family who will attend the meeting, encourage the patient/family not to attend alone (e.g. other family members, friends, translator, spiritual support), and ask if the patient/family have preferences on who should attend or not attend from the care team. 

Initiate initial disclosure 

  • Use language and terminology that the patient/family can easily understand.Avoid speculation or blame. 
  • Introduce the participants to the patient/family, including their functions and reasons for attendance. 
  • Acknowledge the incident or that something unexpected has happened and express apology using the words ‘I’m sorry’. 
  • Provide an overview of how the meeting will run and ask how the patient/family would like to participate. 
  • Ask about concerns and questions the patient/family would like to discuss and offer support or resources if needed. 
  • Share the following information: 
    • the currently known facts of the incident 
    • the steps for ensuring the ongoing care and well-being of the patient (e.g. clinical care, treatment) 
    • a brief overview of the incident analysis process including expected timelines and what the patient/family can expect during the process 
  • Offer the patient/family an opportunity to speak about their experience and ask questions. 
  • Ask about preferences for future involvement and information (how, when, where). 
  • Ask the patient/family to identify a contact person. 
  • Designate a key contact person from the organization who will provide regular updates. 
  • Provide practical and emotional support (e.g. spiritual care services, counselling, social work, family arrangements, reimbursement of expenses associated with the disclosure process). 
  • Document the disclosure discussion in accordance with organizational policies.Include: 
    • the time, place, date, the names and relationships of all attendees 
    • the facts presented 
    • offers of assistance made and the response, questions raised and the answers given 
    • patient/family preferences about future disclosure discussions 
    • plans for follow-up and key contact information for the organization and the patient/family 

Continue disclosure throughout the incident management process as needed 

  • Continue to be engaged with the patient/family according to their preferences: 
    • continue to offer practical and emotional support 
    • transparently correct any incorrect or incomplete information that was provided in previous disclosure meetings 
    • provide new factual information as it becomes available 
    • offer a further apology which might include an acknowledgement of responsibility for what happened as appropriate and in accordance with organizational policies and applicable legislation 
    • describe any actions that are taken as result of the internal analysis such as system improvements in accordance with organizational policies and applicable legislation 
  • Continue to offer updates, and practical and emotional support for providers. 
  • Ensure providers maintain involvement in the disclosure process as appropriate, particularly if leadership takes on a larger role in the post analysis stage. 
  • Continue to document disclosure discussions per organizational policies.