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Rapid response to:


Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study

BMJ 2011; 343 doi: (Published 25 July 2011) Cite this as: BMJ 2011;343:d4423

Rapid Response:

"100 patient stories" - Just one side of the story for improving incident disclosure.

EDITOR - Iedema et al (1) has suggested that despite growing
prominence of open disclosure in healthcare, consumer needs and
expectations following critical incidents are not being met. Recognising
that patient-centred care is core to improving healthcare quality, the
study provides valuable insights into the overarching concerns of patients
and their families with regards to incident disclosure. Whilst the study
has credibility, the implications need to be considered with some caution.

According to the Australian Commission on Safety and Quality in
Health Care,(2) open disclosure should facilitate effective communication
between and across healthcare professionals, patients, support persons,
healthcare managers and all healthcare staff. Despite recognition that
healthcare is multidisciplinary, there are limited studies on open
disclosure that investigate experiences beyond those of doctors and
patients.(3) Herein lies the obvious gap.

Iedema et al (1) identified best practice principles for open
disclosure, based on patients' and families' experiences. The sample
however excluded the views of healthcare professionals and therefore was
not representative of the wider population. We need to understand the
expectations of a broader cross section of healthcare staff and examine
the organisational culture in order to gain a more informed understanding
of why patient expectations of disclosure have not been realised.

Improving incident disclosure is not as simple as applying Iedema et
al's proposed principles.(1) Implementation of best practice principles
for incident disclosure will not correlate with quality improvement if
there are not the systems, resources, and institutional culture to
implement and sustain the changes.

The complexity surrounding incident disclosure is multi-faceted.
Improving quality of care requires a balance to be struck between patient
expectations and the reality of what healthcare can provide in the context
of resourcing, funding, and staffing. Further research of open disclosure
is required to establish realistic and achievable recommendations and
close the gap between the patient expectations and the reality.

1. Iedema R, Allen S, Britton K, Piper D, Baker A, Grbich C, et al.
Patients' and family members' views on how clinicians enact and how they
should enact incident disclosure: the "100 patient stories" qualitative
study. BMJ. 2011;343:d4423.

2. Australian Commission on Safety and Quality in Health Care. Open
Disclosure Standard- A national standard for open communication in public
and private hospitals, following an adverse event in health care. Sydney:
Commonwealth of Australia;2008.

3. O'Connor E, Coates H, Yardley I, Wu A. Disclosure of patient safety
incidents: a comprehensive review. Int J Qual Health Care. 2010;22(5):371-

Competing interests: No competing interests

05 September 2011
Annette S Leong
Manager of Occupational Therapy
Southern Health, Victoria, Australia