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10/26/2011 6:00 PM

​​New Disclosure Guidelines support openness with patients and families

“Disclosure is a process of open communication and information sharing, rather than a single conversation so that improvements to patient safety can be effective. Disclosure is needed for healing and patients and families must receive an apology for what has happened. It is the responsibility of all healthcare providers and the right of every patient.” (Donna Davis, Co-Chair, Patients for Patient Safety Canada)

The Canadian Patient Safety Institute, with the support and involvement of many participating organizations, has released an updated version of The Canadian Disclosure Guidelines: Being Open with Patients and Families. The revised Guidelines will continue to support individuals and organizations in developing or enhancing disclosure policies and practice as a core element of a patient safety culture. The Guidelines were revised to reflect progress made in the evolution of a patient-centered and safety-focused culture of healthcare has made significant progress since the disclosure guidelines were first published in 2008.

“We hope the revised guidelines will create new conversations about disclosure, clarify how best to meet the needs of patients and families, and help align disclosure policies across Canada,” says Hugh MacLeod, CEO, Canadian Patient Safety Institute.

 “The guidelines emphasize the importance of a clear and consistent approach to disclosure, regardless of the reason for the harm,” says Brent Windwick, Chair of the Disclosure Guidelines Working Group.  “Through these guidelines, we hope to support and encourage individuals and organizations to develop or enhance disclosure policies and practice, incorporating and adapting the core elements respective to their needs.”

Underpinning the new Guidelines is the philosophy of supporting disclosure through a just culture. While a healthcare organization’s culture is vital to encourage and sustain safer patient care, the addition of the word “just” reflects a fair and supportive system where the emphasis is on creating a safe learning environment to learn from harmful incidents, bringing about system changes to improve patient care, and if appropriate, the education of providers.

The Canadian Disclosure Guidelines: Being Open with Patients and Families reinforces the importance of providing an apology as a genuine expression of being sorry for what has happened; and outlines the guiding principles and steps involved in the disclosure process.  Some of the major changes include:

  • Clarification of terminology: The new Guidelines introduce new patient safety terminology derived from the International Classification for Patient Safety, developed by the World Health Organization (WHO), including five terms relevant to disclosure, which will provide clarification and consistency:
  • Healthcare associated harm:  Harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury.
    • Patient safety incident: An event or circumstance which could have resulted, or did result, in unnecessary harm to a patient.
      • Harmful incident: A patient safety incident that resulted in harm to the patient. (Replaces “adverse event”)
      • No harm incident: A patient safety incident which reached a patient, but no discernable harm resulted.
      • Near miss: A patient safety incident that did not reach the patient. (Replaces “close call”)
  • Supporting Patients: The new Guidelines emphasize the importance of remaining sensitive to the needs of the patient and family, and taking steps to keep them apprised of actions taken in response to the event; supporting patients clinically, providing psychological and emotional support when they experience harm during a patient safety incident; and ensuring practical and timely access to further healthcare treatment and professional support. 
  • Expense reimbursement: There are new guiding principles on providing expense reimbursement for patients/families to attend disclosure meetings, when the harm a patient suffers is not part of the patient’s underlying condition. These costs may include travel expenses, parking, meals, accommodation, child care and fees for obtaining medical files pertinent to the event.
  • Supporting Healthcare Providers: The new guidelines also emphasize the importance of ensuring emotional and practical support is made available to healthcare providers involved in patient safety incidents or disclosure discussions; and providing education and training to healthcare providers in how to effectively participate in a disclosure discussion.

A draft of the updated Guidelines was initially released in June 2011 for input. Individuals and organizations participated in a national information webinar on the draft document and approximately 250 individuals and organizations participated in a survey consultation process, offering their feedback and recommendations on the draft document.  The Canadian Disclosure Guidelines: Being Open with Patients and Families can be downloaded from the Canadian Patient Safety Institute website:

Discussions on disclosure and the revised document will take place during Canada’s Virtual Forum on Patient Safety and Quality Improvement.   Click here to see the program and to register.