Being open
Communicating with patients and carers
after patient safety incidents
What is Being open?
Being open involves apologising and explaining
what happened to patients who have been harmed as
a result of a patient safety incident. It encompasses
communications between healthcare professionals,
patients and their carers.
Why Being open?
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It’s what patients want.
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It is ethically and morally the right thing to do.
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It reduces litigation costs.
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A vehicle for winning back patient confidence.
What’s going on elsewhere?
 Australian Open Disclosure Project
 JCAHO standards
 US National Patient Safety Foundation
 Kaiser Permanente and VA hospitals
 Academic research studies
The Australian open disclosure project
The project found that patients wanted:
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to be told about patient safety incidents which affect them;
acknowledgement of the distress that they suffered;
a sincere and compassionate statement of regret;
a factual explanation of what happened;
a clear plan about what can be done medically to redress
or repair the harm done.
Being open: ‘Sorry Works!’
‘Sorry Works!’ is the US Being open programme - it found:
 that it removes anger and actually reduces the chances of
litigation and costly defence litigation bills;
 that it worked successfully in organisations like the University
of Michigan Hospital system, Stanford Medical Center,
Children's Hospitals and Clinics of Minnesota, and the VA
Hospital in Lexington, Kentucky.
Making amends
DH survey interviewed 8,000 members of the public:
 34% want an apology or explanation;
 23% want an inquiry into the causes;
 17% want support to cope with the consequences;
 11% want financial compensation;
 6% want disciplinary action.
Duty of candour
Making Amends and General Medical Council emphasise
the importance of a duty of candour:
“If a patient under your care has suffered serious harm,
through misadventure or any other reason, you should act
immediately to put it right, if possible. You should explain
fully to the patient what has happened and the likely short
and long term effects. When appropriate you should offer
an apology.”
GMC, Good Medical Practice Guide, 2001
Being open and litigation
NHSLA and Welsh Risk Pool support openness and
honesty with patients:
“It seems to us that it is both natural and desirable for those
involved in treatment which produces an adverse result, for
whatever reason, to sympathise with the patient and the
patient’s relatives and to express sorrow and regret at the
outcome. Such expressions of regret would not normally
constitute an admission of liability, either in part or full, and it is
not our policy to prohibit them, or to dispute any payment, under
any scheme, solely on the grounds of such an expression of
regret.”
NHSLA, 2002
Being open toolkit
 Policy and safer practice notice:
o what to say, who should say it and when;
 Video based training programme:
o case studies to demonstrate communicating about
incidents
o groups of 16 – using actors to role play scenarios
 E-learning:
o to be available on www.saferhealthcare.org.uk in
November 2005
Learning points
 If the apology does not come early the patient/family
may be more angry.
 An apology is better than an expression of sympathy.
 Being prepared is essential.
 It’s easy to get caught up in explaining the process and
not answering the family’s questions.
 The language you use may be meaningless to the
patient and/or family.
 Don’t inadvertently attribute blame.
Actions for healthcare organisations
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Develop and implement a local Being open policy by
June 2006.
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Identify local Being open leads and clinicians to
attend Being open training workshops.
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Raise awareness of the Being open e-learning
locally and ensure staff have access to it.
Any questions?
www.npsa.nhs.uk