Being open: Communicating with patients and carers after patient safety incidents

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Being open Communicating with patients and
carers after patient safety incidents
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What is Being open?
Being open involves apologising and explaining
what happened to patients who have been harmed
as a result of a patient safety incident. It
encompasses communications between
healthcare professionals and patients and their
carers.  
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Why Being open ?

• Its what patients want
• It is ethically and morally the right thing to do
• It reduces litigation costs
• Vehicle for winning back patient confidence

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Whats going on elsewhere?

• Australian Open Disclosure Project
• JCAHO standards
• US National Patient Safety Foundation
• Kaiser Permanente and VA hospitals
• Academic research studies

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The Australian open disclosure project

• Consultation involving key stakeholders
• National standard for open disclosure
• CD-Rom based training
• Organisational readiness for open disclosure

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The Australian open disclosure project

• To be told about patient safety incidents which
  affect them
• Acknowledgement of the distress that the patient
  has suffered
• A sincere and compassionate statement of regret
• A factual explanation of what happened
• A clear plan about what can be done medically to
  redress or repair the harm done

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Sorry works!

• US Being open programme
• removes anger and actually reduces the chances of
  litigation and costly defence litigation bills.
• worked successfully at hospitals such as the
  University of Michigan Hospital system, Stanford
  Medical Center, Children's Hospitals and Clinics
  of Minnesota, and the VA Hospital in Lexington,
  Kentucky.

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Making Amends
8,000 members of the public interviewed

• 34 want an apology or explanation
• 23 want an inquiry into the causes
• 17 want support to cope with the consequences
• 11 want financial compensation
• 6 want disciplinary action

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Duty of candour

• Making Amends and General Medical Council
  emphasise the importance of a duty of candour.
• If a patient under your care has suffered
  serious harm,
• through misadventure or any other reason, you
  should act
• immediately to put it right, if possible. You
  should explain
• fully to the patient what has happened and the
  likely short
• and long term effects. When appropriate you
  should offer
• an apology.
• GMC, Good Medical Practice Guide, 2001

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Being open and litigation

• NHSLA and Welsh Risk Pool support openness and
  honesty with patients.
• It seems to us that it is both natural and
  desirable for those
• involved in treatment which produces an adverse
  result, for whatever
• reason, to sympathise with the patient and the
  patients relatives and to
• express sorrow and regret at the outcome. Such
  expressions of regret
• would not normally constitute an admission of
  liability, either in part or full,
• and it is not our policy to prohibit them, or to
  dispute any payment, under
• any scheme, solely on the grounds of such an
  expression of regret.
• NHSLA, 2002

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NPSA Being open Toolkit

• Policy and Safer Practice Notice
• What to say, who should say it and when
• Video based training programme
• Case studies to demonstrate communicating about
  incidents
• Groups of 16 using actors to role play
  scenarios
• E-learning
• To be available on www.saferhealthcare.org in
  October 2005

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Learning points

• If the apology does not come early the
  patient/family will be more angry
• An apology is better than an expression of
  sympathy
• Being prepared is essential
• Its easy to get caught up in explaining the
  process and not answering the familys questions
• The language you use may be meaningless to the
  patient and/or family
• Dont inadvertently attribute blame

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Actions for healthcare organisations

• Develop and implement a local Being open policy
  by June, 2006
• Identify local Being open leads and clinicians to
  attend Being open training workshops
• Raise awareness of the Being open e-learning
  locally and ensure staff have access to it

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• Thank you for listening
• Any questions?
• www.npsa.nhs.uk