“Patients and their families expect to be told when something has happened that has harmed them or had the potential to harm them. Patients have the right to know this information. Informing them honestly and fully is the right thing to do”.[1]
Acknowledging that patient incidents do happen is important to taking personal and organizational steps to improvement. Although most of the time things go well in healthcare, sometimes things do not go as planned. As a general principle, any time a patient suffers harm, for any reason, the healthcare provider or organization should communicate to the patient about the harm. This is the final article a series highlighting a key patient safety topic.
What are the Key Elements Required in Responding to and Disclosing Harmful Incidents?
In Manitoba, disclosure of critical incidents to patients is required by law as outlined in The Regional Health Authorities Act. The Act outlines requirements for reporting, investigation and disclosure of critical incidents occurring during the provision of health care services by regional health authorities, and health corporations, health care organizations and provincial organizations as defined in the Act. Depending on the jurisdiction, the disclosure policy may include critical incidents, and may extend to incidents in which there is potential for harm, and/or when no harm is apparent. Disclosure, a process of informing patients and families about harmful incidents, reflects the national and international leading practice guidelines that support open and honest disclosure of patient safety incidents. This is important for all concerned – patients, families, healthcare providers, and the organization.
When Disclosure Should Take Place?
The Canadian Institute for Patient Safety provides guidance on the requirements for disclosure for different types of harm and no harm events[2]. It may be difficult to identify the factors associated with the patient’s harm. For example, it could be associated with a breakdown in the system, a risk that is inherent in the patient’s treatment, the progression of the patient’s condition, or a combination of these situations. The analysis of the event will provide better understanding of the circumstances and factors associated with the incident. For this reason, disclosure is considered to be a process that occurs over time.
Initial disclosure should occur as soon as possible after the recognition of the event. This will help start to rebuild the relationship of trust, openness and transparency. Leading practice (and a requirement for regional health authorities, and health corporations, health care organizations and provincial organizations falling under the critical incident reporting legislation) is that patients/families receive information following a critical incident including:
- the facts of what actually occurred regarding the critical incident
- the actions taken to date and those that will be taken to address the consequences of the critical incident, including any health services, care or treatment that is advisable
- offer any additional facts and the consequences for the individual involved as they become known
- advise them on what progress has taken place to reduce the likelihood that the incident does not happen again to others
The Importance and Impact of an Apology
Disclosing and apology go hand in hand. Apologizing demonstrates our humanity and the concern we feel. A sincere apology can help to lessen the emotional impact of the harm, and will be therapeutic for not only the patient but for the healthcare providers as well.
In Manitoba, The Apology Act allays fears and concerns of liability, and allows healthcare providers to apologize freely. Under the act[3]
- apologizing does not create legal liability
- an apology does not void, impair or affect your malpractice or liability insurance coverage
- an apology is not admissible in court, including “a tribunal, an arbitrator and any other person who is acting in a judicial or quasi-judicial capacity”[4] such as disciplinary and grievance hearings, and civil litigation
- it does not apply to criminal offenses, such as sexual or physical assault, which fall under federal jurisdiction
If You are Involved in a Patient Incident
Being involved in a patient incident can be stressful. Emotional support may help you deal with your feelings. For help, call Klinic Community Health, 24 hours/day, at 204-788-8222 or 1-833-788-8222. You can also obtain support[5] from:
- “Physicians at Risk”
- a member of your critical incident stress management team
- Your:
- social worker
- spiritual care worker
- benefit plans, such as Employee Assistance Program
- professional association
- union
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1. Foundation |
The organization ensures that it has defined processes, policies, and procedures that explain the way in which it will respond to patient incidents. Staff are appropriately educated and deemed competent in the disclosure process. |
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2. Preparation for the Initial Disclosure |
The organization ensures that an appropriate team is assembled, with clear assignments to support the patient/family through the entire disclosure process. The organization is clear about who will be present, the facts that will be shared, when and how the meeting will be conducted, and the identification of a lead team member to guide the process. |
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3. Initial Disclosure |
The organization ensures that the facts are shared in a manner that makes it easy for the patient/family to fully understand the entire scope of what is known. It is key that the team expresses they are sorry in a way that is perceived as open, sincere, and culturally sensitive by the patient/family. A skilled team completes an analysis of the event. |
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4. Post-Analysis Dislosure |
The team shares all additional facts discovered, and any actions taken. The full process is documented in accordance with the organization’s processes.
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5. Sharing Lessons Learned |
Learning from patient incidents is the cornerstone of improvement. Provide updates on lessons learned and improvements made as a result of the analysis of the incident as part of routine processes, e.g. regular agenda item at staff and board meetings, “good catch” stories in newsletters and in interprofessional forums. The Canadian Patient Safety Institute (CPSI) “Global Patient Safety Alerts”,[7] supports organizations across Canada and the world in learning from each other. |
There are many references and websites available on disclosure and apology. For more information, see www.mips.ca Resources, Tips & Research or call 1-866-927-6477.
Patient safety – make it YOUR responsibility!
[1] Manitoba Institute for Patient Safety and the Manitoba Alliance of Health Regulatory Colleges. Apology Act Information Sheet. 2014
[2] Disclosure Working Group. Canadian Disclosure guidelines: being open and honest with patients and families. Edmonton, Alberta: Canadian patient Safety Institute 2011.
[3] Manitoba Institute for Patient Safety and the Manitoba Alliance of Health Regulatory Colleges. Apology Act Information Sheet. 2014
[4] Government of Manitoba. The Apology Act. http://web2.gov.mb.ca/laws/statutes/ccsm/a098e.php
[5] Manitoba Institute for Patient Safety. The Facts about Critical Incidents and their Disclosure. Frequently Asked Questions for Healthcare Providers. 2018 https://mips.ca/hp-critical-incidents.html
[6] Manitoba Institute for Patient Safety. Learn to be Safe – A Simulation Learning Experience. Patient Safety: A Primer. 2011 https://mips.ca/hp-communication.html
[7] Canadian Patient Safety Institute, 2011. Available at http://www.patientsafetyinstitute.ca/en/newsalerts/alerts/pages/default.aspx
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