On behalf of Medical Protection, Patricia Canedo, Policy and Public Affairs Manager, and James Lucas, Medicolegal Consultant, recently submitted a response to the Public Consultation on a draft Policy Framework for Open Disclosure in the Irish Health Sector by the Department of Health. 

The Irish Department of Health has recently consulted on their draft policy on Open Disclosure. This follows a 2021 consultation on Open Disclosure policy by the HSE, which we also responded to. 

The Department defines Open Disclosure as an open, consistent, compassionate, and timely approach to communicating with patients and, where appropriate, their relevant person following patient safety incidents. The Department establishes that open disclosure includes expressing regret for what has happened, keeping the patient informed, and providing reassurance in relation to on-going care and treatment, learning, and the steps being taken by the health services provider to try to prevent a recurrence of the incident.

At Medical Protection, we strongly advocate for an open culture which fosters learning and we fully support a culture of openness in the healthcare sector. We advise members that they should apologise when something goes wrong. However, we believe that the current blame-oriented system which holds individual healthcare practitioners to account when something goes wrong is a barrier in creating this open culture.

In our view, the key to achieve an open culture is cultural change, which can take time to achieve but which is possible by fostering a culture of learning and openness with enhanced oversight through contractual commitments and with professional regulation overseeing it.

In order to create cultural change, individual healthcare professionals need to feel able and empowered to disclose when things go wrong, apologise to patients and learn from mistakes so that avoidable errors are reduced in the future and so patient safety is improved. 

However, for individual healthcare professionals to be open, they must be supported at management and organisational level so that they feel able to express candour, apologise and learn from mistakes. The Government and healthcare managers need to encourage organisations to develop policies and processes to support open communications and the notification of adverse events and near misses, and in this way we have expressed to the Department of Health our support for an open disclosure policy.

In our experience, a significant proportion of adverse incidents are avoidable, and it has been proven that the underlying cause of the majority of adverse incidents in medicine is either systems failure, or a combination of systems failure and individual error. Therefore, adverse event reporting is central to improving patient safety, as it provides the opportunity to learn how to prevent the same thing happening again. 

We have also recommended to the Government that open disclosure policy should be included into all programmes at undergraduate and postgraduate level. We believe that engraving this concept into education could be one of the most effective ways to install a just culture and ensure that clinicians feel comfortable explaining what has gone wrong and offering an apology.

Lastly, we also asked the HSE that while we understand the need for a very lengthy and detailed document outlining the Open Disclosure policy, busy clinicians will benefit from a summarised version alongside the document with only the relevant points for clinicians to refer to.

Medical Protection will continue to advocate for a move from a blame culture, in which currently Ireland operates to an open culture where learning from events is fostered, while ensuring that we protect and support our members.