All practitioners try to avoid harm when treating their patients but if something does go wrong, being honest and open about what has happened needs to be the starting point of making things right.

The type of harm a patient might experience during or as a result of treatment can include physical, social or psychological harm. 

No matter how a patient has been harmed by healthcare (also known as an adverse event), you have a responsibility to communicate openly and honestly with them to review what happened and to report appropriately. 

Physiotherapy Board of Australia chair Dr Paula Harding said these conversations need to be guided by the principles of open disclosure, which include acknowledging and apologising for the harm and giving the patient the opportunity to share their experience. 

‘In many cases, these are the most important steps a practitioner can take to help their patient get through what has happened,’ Paula said. 

‘It’s not only important for patients; it also helps practitioners reflect and move on with a greater understanding of their own practice.’ 

Physiotherapy Council of NSW president Toni Andary suggested that any apology should be timely and that the clinician receiving the complaint should employ active listening techniques to make sure they can learn from the experience and prevent a similar situation from happening again. 

‘Open disclosure is a difficult process that, in the long term, has the potential to enhance the public’s trust and confidence in our profession and the healthcare organisation we represent.’ 

Key information and principles 

The Australian open disclosure framework defines open disclosure as the open discussion of adverse events that resulted in harm to a patient when receiving healthcare, with the patient and their family and carers. 

It is a discussion between two parties, with an exchange of information that may take place in several meetings over time. 

The framework contains eight guiding principles: 

• open and timely communication
• acknowledgement
• apology or expression of regret
• supporting and meeting the needs and expectations of patients, their families and carers
• supporting and meeting the needs and expectations of those providing healthcare
• integrated clinical risk management and systems improvement
• good governance
• confidentiality. 

In practice, this means that discussions based on open disclosure should include an apology using the words ‘I am sorry’ or ‘we are sorry’, a factual explanation of what happened and an opportunity for the patient and their family and carers to talk about their experience. 

The discussion should also include the potential consequences of what happened and what is being done to stop it happening again. 

Physiotherapists can refer to the Ahpra Code of conduct for examples of good practice when something goes wrong, including applying open disclosure principles and non-punitive approaches to incident management. 

The Australian open disclosure framework also provides information on organisational preparedness, key considerations and actions during the open disclosure process. 

The level of response required is determined by the effect, severity or consequence of the incident.

Higher-level responses involve a more comprehensive open disclosure process, while lower-level responses rely on a briefer open disclosure process. 

Health service organisations and employers including private practice owners may have specific open disclosure policies and procedures as part of their risk controls. 

It is important to be informed about the Australian open disclosure framework, information in the Code of conduct on adverse events and open disclosure, and any open disclosure policies and procedures of your organisation or practice. 

Some states and territories may have a statutory duty of candour that could also apply to you. If you are unsure about your obligations, you should seek advice from your employer or professional indemnity insurer. 

Being familiar with open disclosure will help you effectively manage risk, respond to adverse events and provide safe and professional practice. 

Open disclosure also fosters public confidence in the safety of your services by ensuring that patients and other relevant individuals are fully informed about what has gone wrong and the actions being taken to prevent harm from reoccurring. 

Click here and here for more information.