Disclosure is a formal process involving open discussion between a patient/family and members of the 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 as well as promotes healing for the patients/families and providers involved. It generally occurs in two broad stages (initial and post-analysis) recognizing that it 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 organizational processes that support disclosure.
Establish guiding principles for disclosure (e.g. patient-centred healthcare, patient autonomy, honesty and transparency, patient safety, just culture, learning and improvement)
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 the 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
After an incident: 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
Ensure to:
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
After an incident: 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
