Dr Michelle O'Driscoll: What is open disclosure?

There has been a lot in the media recently about ‘open disclosure’ in relation to healthcare. But what exactly is it?

Open disclosure in healthcare means that you will be communicated with in an open, honest, timely and transparent manner if:

something goes wrong with your care

you experience harm as a result of your care

the healthcare team think that harm may have occurred as a result of your care

The HSE advises that open disclosure should include expressing regret for what has happened, with an apology where appropriate, keeping the patient informed, and providing reassurance in relation to ongoing care and treatment, learning, and the steps being taken by the health services provider to try to prevent a recurrence of the incident.

While this sounds like a reasonable expectation of your care, this wasn’t until recently consolidated in law as a requirement. To address this, a new piece of legislation, The Patient Safety (Notifiable Incidents and Open Disclosure) Act was enacted in June, 2023. This followed on from the previous Patient Safety (Notifiable Patient Safety Incidents) Bill 2019.

The previous law ensured that patients should be told when an incident in relation to their care occurred. However, the process by which this took place, or other specific details, were not clear and lacked consistency.

The new Act gives more detail around how communications occur with a patient around the care received, with mandatory open disclosure of a list of specified serious patient safety incidents that must be disclosed to the patient and/or their family.

It also requires the notification of these to the Health Information and Quality Authority, Chief Inspector of Social Services, and the Mental Health Commission.

The HSE have a new draft Open Disclosure policy document which was open to the public for comment until this week. They will take the feedback received into account to inform any changes going forward. The document can be read at: https://www.hse.ie/eng/about/who/qid/other-quality-improvement-programmes/opendisclosure/

This document is a comprehensive overview of what open disclosure should look like, and what systems should be in place to make it happen. It covers the types of events that should be openly disclosed to patients and their carers, the type of communication that you should receive, including an apology or expression of regret, confidentiality, the record keeping that should happen, and the governance that should support the process. Ten principles of open disclosre are outlined in the appendix at the end of the document.

As a patient or carer, we hope that this law never needs to be called upon in relation to the care of ourselves or a loved one, but things can unfortunately happen, whether due to poor practice or human error, that you may need to be kept informed of. The hope is that a lot of what this law contains was happening in healthcare anyway. This law is in place to protect those rights to be communicated with appropriately at all times.

Healthcare courses are incorporating this information and training into their degrees so that their graduates are fully familiar with what is required of them in their interactions with patients.

Going forward, be confident in the knowledge that you’re protected by the law in this regard, and can expect the highest of standards in terms of the communication you receive around any adverse events in relation to your care.

You can bring any questions around open disclosure to your healthcare professional who will explain it to you in more detail if you wish. Further information is available on gov.ie