Abstract
Background: New Zealand health and disability providers are expected to have local open disclosure policies in place, however, empirical analysis of these policies has not been undertaken. Aim: This study aims to (1) examine the scope and content of open disclosure policies in New Zealand (2) compare open disclosure policies in New Zealand, and (3) provide baseline results for future research. Methods: Open disclosure policies were requested from all twenty New Zealand District Health Boards in June 2016. A total of twenty-one policies were received, with nineteen policies included in the review. The data were analysed using conventional content analysis. Areas of identified guidance were categorised categorized under the headings: 1) identification of an adverse event, 2) actions before disclosure, 3) disclosure of harm, and 4) actions after disclosure. Results: A total of forty-six distinct areas of guidance could be categorized under the different phases of the open disclosure life-cycle. Conclusion: This review has identified significant unwarranted heterogeneity and important gaps in open disclosure documents in New Zealand which urgently needs to be addressed. Open disclosure policies which are both flexible and specific should enhance the likelihood that injured patients’ needs will be met.
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References
Australian Council for Safety and Quality in Health Care. 2003. Open disclosure standard: A national standard for open communication in public and private hospitals, following an adverse event in health care. Sydney: Australian Council for Safety and Quality in Health Care.
Australian Commission on Safety and Quality in Health Care. 2008. Open disclosure standard: A national standard for open communication in public and private hospitals, following an adverse event in health care. Sydney: Australian Commission on Safety and Quality in Health Care.
———. 2012. Open disclosure standard review report. Sydney: Australian Commission on Safety and Quality in Health Care.
———. 2013. Australian open disclosure framework. Sydney: Australian Commission on Safety and Quality in Health Care.
Canadian Patient Safety Institute. 2008. Canadian disclosure guidelines. Ottawa: Canadian Patient Safety Institute.
Gallagher, T.H., S.K. Bell, K.M. Smith, M.M. Mello, and T.B. McDonald. 2009. Disclosing harmful medical errors to patients: Tackling three tough cases. Chest 136(3): 897–903.
Garbutt, J., D.R. Brownstein, E.J. Klein, et al. 2007. Reporting and disclosing medical errors: Pediatricians’ attitudes and behaviors. Archives of Pediatrics & Adolescent Medicine 161(2): 179–185.
Hartnell, N., N. MacKinnon, I. Sketris, and M. Fleming. 2012. Identifying, understanding and overcoming barriers to medication error reporting in hospitals: A focus group study. BMJ Quality and Safety 21(5): 361–368.
Health and Disability Commissioner. 2009. Guidance on open disclosure policies. http://www.hdc.org.nz/media/2981/guidance-on-open-disclosure-policies-dec-09.pdf Accessed April 6, 2018.
Health Quality & Safety Commission New Zealand. 2012. New Zealand health and disability services—National reportable events policy 2012. https://www.hqsc.govt.nz/assets/Reportable-Events/Publications/Reportable-Events-Policy-Final-Jan-2013.pdf. Accessed April 6, 2018.
———. 2017. Learning from adverse events. 1 July 2016 to 30 June 2017. What are the individual DHB figures? https://www.hqsc.govt.nz/assets/Reportable-Events/Publications/AEReport_DHB_figures.pdf. Accessed May 13, 2018.
Hsieh, H.F., and S.E. Shannon. 2005. Three approaches to qualitative content analysis. Qualitative Health Research 15(9): 1277–1288.
Iedema, R., N. Mallock, R. Sorensen, et al. 2008. Final report: Evaluation of the national open disclosure pilot program. Sydney: Australian Commission on Safety and Quality in Health Care.
Iedema, R., S. Allen, R. Sorensen, and T.H. Gallagher. 2011. What prevents incident disclosure, and what can be done to promote it? Joint Commission Journal on Quality and Patient Safety 37(9): 409–417.
Institute of Medicine. 2000. To err is human: Building a safer health system. Washington, D.C.: The National Academies Press.
Johnston, M. 2013. Living in the shadow of CJD. New Zealand Herald, February 5. http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10863457. Accessed April 6, 2018.
Lazare, A. 2006. Apology in medical practice: An emerging clinical skill. JAMA 296(11): 1401–1404.
Manning, J. 2010. Access to justice for New Zealand health consumers. Journal of Law and Medicine 18(1): 178–194.
Maguire, E.M., B.G. Bokhour, T.H. Wagner, et al. 2016. Evaluating the implementation of a national disclosure policy for large-scale adverse events in an integrated health care system: Identification of gaps and successes. BMC Health Services Research 16(1): 648.
Massachusetts Coalition for the Prevention of Medical Errors. 2006. When things go wrong: Responding to adverse events. A consensus statement of the Harvard hospitals. http://mitss.org/wp-content/uploads/2017/10/respondingToAdverseEvents.pdf. Accessed April 6, 2018.
Mazor, K.M., S.R. Simon, and J.H. Gurwitz. 2004. Communicating with patients about medical errors: A review of the literature. Archives of Internal Medicine 164(15): 1690–1697.
McLennan, S.R., S. Engel-Glatter, A.H. Meyer, D.L.B. Schwappach, D.H. Scheidegger, and B.S. Elger. 2015. Disclosing and reporting medical errors: Cross-sectional survey of Swiss anaesthesiologists. European Journal of Anaesthesiology 32(7): 471–476.
Moore, J., M. Bismark, and M.M. Mello. 2017. Patients’ experiences with communication-and-resolution programs after medical injury. JAMA Internal Medicine 177(11): 1595–1603.
Moore, J., and M.M. Mello. 2017. Improving reconciliation following medical injury: A qualitative study of responses to patient safety incidents in New Zealand. BMJ Quality and Safety 26: 788–798.
National Patient Safety Agency. 2009. Being open: Saying sorry when things go wrong. https://qi.elft.nhs.uk/wp-content/uploads/2013/12/being-open-framework.pdf. Accessed April 6, 2018.
New Zealand Law Commission. 2012. The public’s right to know: Review of the official information legislation. http://www.lawcom.govt.nz/sites/default/files/projectAvailableFormats/NZLC%20R125.pdf. Accessed April 6, 2018.
New Zealand Ministry of Health. 2008. Health and disability services standards NZS 8134. Wellington: Ministry of Health.
New Zealand Ministry of Health. 2016. Private health insurance coverage 2011–15: New Zealand Health Survey. https://www.health.govt.nz/publication/private-health-insurance-coverage-2011-15-new-zealand-health-survey. Accessed December 17, 2018.
Prouty, C.D., M.B. Foglia, and T.H. Gallagher. 2013. Patients’ experiences with disclosure of a large-scale adverse event. Journal of Clinical Ethics 24(4): 353–363.
Reason, J. 1990. Human error. Cambridge: Cambridge University Press.
Truog, R.D., D.M. Browning, J.A. Johnson, T.H. Gallagher, and L.L. Leape. 2010. Talking with patients and families about medical error: A guide for education and practice. Baltimore: Johns Hopkins University Press.
Walton, M., R. Harrison, J. Smith-Merry, et al. 2017. Disclosure of adverse events: A data linkage study reporting patient experiences among Australian adults aged >45 years. Australian Health Review. https://doi.org/10.1071/AH17179.
White, A.A., D.M. Brock, P.I. McCotter, S.E. Shannon, and T.H. Gallagher. 2017. Implementing an error disclosure coaching model: A multicenter case study. Journal of Healthcare Risk Management 36(3): 34–45.
World Health Organization. 2009. WHO patient safety research. Geneva: World Health Organization.
Wu, A.W., L. McCay, W. Levinson, et al. 2017. Disclosing adverse events to patients: International norms and trends. Journal of Patient Safety 13(1): 43–49.
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McLennan, S., Moore, J. New Zealand District Health Boards’ Open Disclosure Policies: A Qualitative Review. Bioethical Inquiry 16, 35–44 (2019). https://doi.org/10.1007/s11673-018-9894-1
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DOI: https://doi.org/10.1007/s11673-018-9894-1