A central component of a just, patient safety culture includes the disclosure of serious medical incidents to those who are affected (open disclosure). The concept of openly disclosing the details of medical incidents has been adopted by several organisations and medical authorities including ones in Canada,1 New Zealand,2 the United Kingdom,3 the United States,4 and perhaps the earliest adopter, Australia,5 which implemented a national open disclosure policy in 2003. The qualitative study by Iedema and colleagues (doi:10.1136/bmj.d4423) explores, from individual patients’ perspectives, the successes and problems associated with the execution of the Australian open disclosure policy.6 The study underlines many important messages for organisations that have or are considering an open disclosure policy.

The findings indicate that much work is needed to engage patients and families in open disclosure, and the study provides a long list of important activities and behaviours associated with successful open disclosure. Research and clinical experience suggest that several items from the list are central …