Disclosure 

Disclosure is a formal process involving open discussion between a patient/family and members of a 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 and promotes healing for the patients/families and providers involved.  

It generally occurs in two broad stages (initial and post-analysis) and is an ongoing process in which multiple disclosure conversations occur over time.  

Recommended Strategies 

Before an incident 

Confirm that organizational processes support disclosure 

• Establish guiding principles for disclosure (e.g. patient-centred healthcare, patient autonomy, honesty and transparency, patient safety, just culture, learning and improvement). 
• Develop disclosure policies, procedures and tools aligned with the organization’s guiding principles, disciplinary/accountability systems, legislation, regulatory/licensing requirements, and best practices that: 
  • involve patients/ families and frontline staff in their development 
  • articulate when and where disclosure should take place and how it should be conducted 
  • include supports and resources available to the patient/family and healthcare providers 
  • provide guidance on how to deal with the media in the event of a public disclosure 
  • incorporate processes that address special circumstances such as multi-patient disclosures, paediatric patients or those with mental health issues, or incidents related to research 
  • are easily accessible to all, including frontline staff and patients/families (e.g. public site) 
  • are updated regularly to ensure relevance and alignment with other policies and current context 
• Provide disclosure training programs and educational resources for staff and patients/families. 
• 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 an 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. 

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. 
• 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 

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.