The safety of service users is of paramount importance and steps need to be taken to anticipate and avoid things going wrong and to reduce the impact if they do. All employees including medical staff are required to disclose and report incidents in line with the HSE's Safety Incident Management Policy. Creating a culture of open disclosure and learning from the things that go wrong is the bedrock of making systems safer. Open Disclosure is defined as 'an open consistent approach to communicating with patients and their families when things go wrong in healthcare. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event'.
In November 2015 the Government gave its approval to the drafting of provisions to support open disclosure of patient safety incidents. This will be included in the Department of Justice and Equality’s Civil Liability (Amendment) Bill which is well advanced. The legislation is part of a broader package of reforms aimed at improving the experience of those who are affected by adverse events.
The background to the proposed legislation lies in the Commission on Patient Safety and Quality Assurance which recommended that legislation be enacted to provide legal protection/privilege for open disclosure of adverse events to patients. The provisions are therefore designed to give legal protection/privilege for the information and apology made to a patient when made in line with the legislation. The apology cannot be interpreted as an admission of liability and cannot be used in litigation against the provider. This approach is intended to create a positive voluntary climate for open disclosure and will support the National Policy on Open Disclosure which was developed jointly by the HSE and the State Claims Agency in November 2013.
This legislation builds on the joint development by the HSE and State Claims Agency of the National Policy on Open Disclosure (2013). The HSE is progressing the implementation of the Policy across all health and social care services. We all know that when error or harm is experienced by a patient, the trust and confidence of that patient and their family are compromised. That is why honest, open disclosure and communication, which demonstrate empathy and sensitivity, are so essential. The intent of this legislation is to provide certain legal protections for health care staff for open disclosure. This will give further support to those staff in their communications with patients and family members if an adverse event occurs. The Ethical Code of Practice set out by the Medical Council also makes clear the responsibilities of doctors in relation to open disclosure.
The open disclosure provisions form part of a number of initiatives to improve the management of patient safety incidents. HIQA and the Mental Health Commission are at an advanced stage of development of Standards on the Conduct of Reviews of Patient Safety Incidents which expand on the National Standards for Safer Better Healthcare. This set of standards along with the mandatory reporting of serious reportable events provided for in the Health Information and Patient Safety Bill and the provisions intended for open disclosure will provide a comprehensive patient-centred approach to preventing, managing and learning from incidents.
