Health Consumer Journey: Open Disclosure System In Healthcare Essay.

Discuss about the Exploration Of Implementation Of Open Disclosure Of Adverse Event.

Medical Misadventures in Healthcare

The essay brings about the discussion of the health consumer journey in any healthcare system, and the related aspects. Every healthcare system identifies some clinical incidents or misadventures during the treatment of their patients depending upon the case. Medical misadventures are increasing day-by-day causing harm to the patient, also affecting the healthcare. Number of cases associated to death of the patient is reported frequently, leading to the increasing medical lawsuits in the healthcare settings. Misadventures or incidents are the results of the errors or faults in the treatment of the patients (Hall, Orentlicher, Bobinski, Bagley & Cohen, 2018). 

As the topic discusses about the applied law and ethics for the health service managers, it is assumed that like other organisations, healthcare system must be ethical in their operations. Health service managers must aim at reducing medical errors, which may occur due to human mistake or some technical issue, so that they can enhance patient safety. In addition, to ensure patient safety, it is done to ensure the health and wellbeing of the patient. Therefore, the duties and responsibilities of the clinical staff in the hospitals are important factors in ensuring patient health and safety through the effective implementation of the open disclosure plan. Thus, the essay in the later part describes about the open disclosure system well in the healthcare, and the ethical and legal considerations in medical terms (Harrison, Walton, Manias, Mears & Plumb, 2017).

In the healthcare system, effective management of the health and safety is a major concern, which determines the efficiency in clinical practices and positive outcomes. According to the perspectives of the clinical professionals, it has stated that they believe that open disclosure increases the probability of the lawsuit, in relation to the mishap in clinical practices. Misadventures in the clinical practices described in many forms, such that they occur as medication errors, complications in the surgery, procedural errors, misdiagnosis, nosocomial infections, fall, or slips during the treatment period. This leads to the patient taking legal actions with respect to the problems faced by them, perceived by improper handling, poor communication or due to the delay in treatment even after identifying the event. The legal actions or decisions taken by the patient and their family, has led to the emergence of the introducing the open disclosure (Birks, Harrison, Bosanquet, Hall, Harden, Entwistle & Adamson, 2014).

Open disclosure itself discusses the meaning of the term, i.e. open discussion of the incidents in the presented healthcare to their patients, family, and other support persons. Disclosure of the incidents to the patient carried out during the time-period of their treatment, and it is the right of patients, therefore anchored in the clinical practices. The necessary elements of the open disclosure system described in the national Australian Open Disclosure Framework.  The Commission and the authority on 13th march endorsed the open disclosure (OD) framework. The framework is designed to enable the health care organisations, to communicate openly about the incidents and the ill functioning of their practices. Moreover, the framework provides a common and consistent basis for the open disclosure in the Australian healthcare (Boudreau & Lakhani, 2015).

Clinical Incident Management: The Open Disclosure System

The key principles of the open disclosure framework include, expression of the regret, disclosure of the clinical incidents to the patients, support, and training to the clinical staff, clinical governance, ensuring and maintaining confidentiality, and fairness in operations. Not all, but few clinical incidents require the initiation of clinical disclosure process in the healthcare. Few incidents consist, of a clinical incident, which involves a required change in the patient care, thus leading to the application of the process of clinical disclosure. Some other incidents, which may be included, are those incidents that may lead to the serious future health consequences even if the risk probability is less (Clinical Excellence Commission, 2013).

Discussing about the time to be taken for initiation for the open disclosure, to the patient it has been stated that the intimation must be given ideally within 24 hours of the occurrence of the clinical incident. In addition, responsibility to handle disclosure of the clinical incident of the patient must be given to the person, known to the patient in the case. Therefore, considering the aspects of the open disclosure framework in the healthcare system to be incorporated in every healthcare setting as a mandatory practice.

According to the principles of Open disclosure framework, stated that the consumers or the patients are to be given necessary information, well in advance, during the period of health service.  Communicating the cause and effects of the incident is necessary to establish a plan to eradicate the problem and reduce the occurrence of further incidents. Firstly, it is necessary to inform the consumer or the patient about what exactly happened, i.e. about the incident in a timely, open, and honest manner. All the adverse events and the consequences, which might occur in the future described to the patient, and their family members. The information given with respect to the open disclosure, to the patient during health services also includes the steps taken to improve the health of the patient. They need to be given information regarding the process of open disclosure with respect to their case. The process of the OD will include a guide and the technological methods for the consumers/patients and the information related to the positive results of the Open disclosure process (De Rassenfosse, Palangkaraya & Webster, 2016).

Open disclosure framework in the healthcare settings, involves the role of, the patients as well as the staff and other health professionals. Adequate access to the information should be provided to staff, so that they can fulfil their roles and responsibilities. To support the staff members, the health organisations must ensure following things, listed below (Elwy, Bokhour, Maguire, Wagner, Asch, Gifford & Jesse, 2014).  

Necessary Elements of the Open Disclosure System

Staff authorities in the healthcare, must be informed about the incident investigation and the outcomes, obtained from it. The most important information regarding the incident is the skills provided to the staff to effectively manage, and communicate to the patient. Thus, through delivering this kind of information to thee staff, they will be able to get social and psychological support from the health service organisations. Other includes making a provision of the support system, presently available for those clinicians distressed by the incident. The support system available to the clinicians or the health professionals, include the medical defence organisations, doctors, health advisory services, committees and other health service counsellors. In addition, they are given opportunities to discuss about the incident, with the senior doctors or clinicians to get support. It also provides information to the staff on the legal counsel, and the benefits junior clinicians can get from observing and participating in open disclosure (Harrison, Birks, Hall, Bosanquet, Harden & Iedema, 2014).  

Open disclosure framework is designed to provide benefits to the patient, carer/consumer, and clinicians involved in the incident. The process of open disclosure is vital to the clinicians in context to the healthcare. Developing the right attitude, culture, and behaviours amongst consumers or patients in the healthcare for open disclosure is the key responsibility of the managers or executives. Another important thing is to get open disclosure aligned with the organisation’s clinical incident management policies and processes. Every healthcare organisation receives benefits from the managers or managing team with respect to the process of open disclosure. Managerial assistance in the form of better leaders, effective communication, measurement, and evaluation helps in the handling of the open disclosure with the patients (Koller, Rummens, Le Pouesard, Espin, Friedman, Coffey & Kenneally, 2016).

Managers play a key role in supporting the open disclosure process, treated as challenges faced by them in establishing effective open discussion. They develop and foster the discussion of the adverse events or incidents and the apprlopriate strategies to prevent their further occurrence. Healthcare receives benefit from the management as they support and encourage clinicians and colleagues to manage clinical risks, and help patient. The managers as maintain the effectiveness of the open disclosure, they confirm to the standards of making an apology to the patient, through their clinicians. It means they ensure about making apology laws across jurisdictions. Apology should include the words as I am sorry or we are sorry for what has happened as a clinical misadventure. Thus, these are some of the points, which mentions about the managerial assistance or their involvement in providing support to the open disclosure process (Lee, 2016).

Clinical Staff Duties and Responsibilities

Misadventure or any clinical error in the healthcare affects the health condition, of the patients largely. It not only affects their heath condition, rather it influences their perspectives towards the management and treatment given in the healthcare. On the occurrence of any misadventure, necessary information must be given to the consumer, which will provide them an understanding of the case, and the steps to resolve problem (Yeowell, Rooney & Goodwin, 2018).

A consumer or the patient should receive an expression of regret due to any clinical incident is a key component of open disclosure. The resource of the expression of regret has been designed for the clinicians and other participants of open disclosure, to express regret with sincerity and empathy, without creating situation of uncertainty. This is the most important information given to the consumers during or after the clinical misadventure, in the form of apology, as it forms effective open disclosure. To ensure about the effectiveness of the open disclosure, because apologising or expressing regret is must to be in other actions and communication. The consumers of healthcare in the process of open disclosure need to be informed about the investigation on what has happened, and the outcomes of the investigation. The information given ensures improving their experience of the open disclosure process, to the people in the incident, which resulted harming the patient, while receiving the treatment (Watson, Angus, Gore & Farmer, 2015).

Open disclosure process is a medically ethical and legal updated procedure in context to the healthcare settings. The topic underlines the significance of the topic, describing the process of open disclosure when there is harm to the patient, and the case when there is no harm to the patient. No legal or statutory obligations exist for the OD patients after the incident. In legal terms, there is a common law authority which supports OD either as a part of the duty of care or as an implied term in the contract of medical or healthcare services. The legal considerations in the process of open disclosure, whether patient has caused harm or not, states about the issues of apology, privilege, deceptive conduct and the negligent attitude of the healthcare providers and institutions liability are included in legal considerations.

Some of the experienced and famous Australian commentators have described about the disparity between the ethical obligations in OD and the poor practice of them in healthcare. With the increasing medical incidents and health problems to people in the present scenario, medical ethics must aim to become sufficient to drive health professional’s contribution or commitment to the OD process. OD should be implanted directly into the bureaucratic structures of the healthcare systems appropriately based on the grounds of legal and ethical frameworks, encouraging health systems to become transparent; thereby reducing errors and incidents (Gray & Thorpe, 2015).

Managerial Assistance in Open Disclosure

On the occurrence of any misadventure, and the initiation of open disclosure process, there is major contribution of the clinical staff to resolve problems. The clinicians before the conduct of the OD process in the healthcare must have completed their education, for open disclosure to avoid any problem. Further, when the misadventure occurs, and procedure of disclosure is initiated, they are obliged to ensure that the patient is safeguarded from further such harm. The responsibilities of the clinicians also involve apologising to the patient or their respective support system, following a patient-safety incident without mentioning the attribution of blame of the incident. In the cases of clinical misadventures, health service organisations must ensure that the protocols, policies and the practices for open disclosure emphasize on restoration, recovery, and improving quality and patient safety (Wong, Tan, Heng, Ramesh, Ting, Lee & Kee, 2016).

The Open disclosure framework” discusses the principles of the open disclosure process and provides a consistent basis for communication in healthcare following an adverse healthcare incident. The outline or the framework for the open disclosure process can be described through the following points (Schünemann, Al-Ansary, Forland, Kersten, Komulainen, Kopp & Qaseem, 2015). 

The first step in the process of open disclosure after identifying any clinical misadventure includes identification of the incident, then moving on to the next step of acknowledging to the patient about what has happened. It is a kind of conversation with the patient about the misadventure and the related facts. The third step in the open disclosure process relates to the reporting of the incident in the safety learning system and the document in the medical records. After the incident has been reported and recorded in the documents of the medical records, it is the responsibility of the manager to review the incident. The manager reviews the incident and the severity of the event, telling the patient about the same. The manager usually does reviewing the misadventure within 2 working days. Manager performs the task of finalising the outcome from the review of the incident and then develops an appropriate course of action for the improvement of the case. The incident or the misadventure of the case is usually improved and the clinicians aim to fix the problem within 30 days (McLennan, Diebold, Rich & Elger, 2016).

Now, as the healthcare service managers or the clinicians in the healthcare settings, with respect to the reported clinical misadventure, have taken the action an analysis of the action to be done. The analysis in clinical terms or feedback, involves providing feedback to the staff members (notifier). In addition, feedback to patients on the actions taken to reduce the possibility of the recurrence of such misadventures. Thus, the process determines and ensures about the minimal reporting of such adverse events, ensuring patient safety, and health (Shahmirzadi, Chao, Palmaer, Parra, Tang & Gonzalez, 2014).   

Conclusion

The outline or the process of open disclosure has been discussed and stated clearly through the flowchart given below:

(Source: Clinical Excellence Commission, 2018)

The critical success factors associated with the application of open disclosure includes a supportive hospital environment and organisational culture, which positively influences departments at all the levels and the activities conducted. The implementation of the OD process mentions about a pilot lead in hospital responsible for implementation, policy development, awareness, training and championing the process of open disclosure. The others success factors describe about the supportive culture of disclosure in the healthcare which tends to promote confidence and morale of the staff and their ability to implement the process in the organisation (White, Wright, Baber & Barrera, 2017).         

The effectiveness of the process of open disclosure can be achieved in a number of ways, articulated in number of books. With context to the healthcare settings, a key recommendation of global policy on medical error disclosure process is to apologise to the patient for the misadventure. The health professionals should be encouraged to prepare open disclosure after given training for the same.  Health policies must focus on increasing the involvement of carer, patient, or their family in the open disclosure. One of the most important suggestions is to make sure that there should be no-harm incident to the patients. It must be incorporate in every healthcare, as a crucial strategy in context to the incident management (Kalra, 2016).

Conclusion

To conclude the above discussion on the essay of clinical misadventures and the related aspects it has been analysed that open disclosure play a critical role determining patient’s health. Open disclosure is an important step towards identifying occurrence of clinical misadventures and reducing their recurrence in the future. The essay describe about the significant information to be disclosed to the consumers/patients, and the staff members of the healthcare, to enhance their skills to manage incidents. In addition, there is a detailed analysis of the process and the duties and responsibilities of the staff and manager with context to the reported clinical misadventure. The relationship between the patient and health professionals or clinicians is impacted due to such adverse events. Therefore, every healthcare organisation must focus on improving their services and reduce cases by integrating mechanism of open disclosure in their system; thus ensuring patient wellbeing.

References

Birks, Y., Harrison, R., Bosanquet, K., Hall, J.,  Harden, M., Entwistle, V.  & Adamson, J. (2014).  An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration. Health Services and Delivery Research, 2(20), 210-220.

Boudreau, K. J. & Lakhani, K. R. (2015). “Open” disclosure of innovations, incentives, and follow-on reuse: Theory on processes of cumulative innovation and a field experiment in computational biology. Research Policy, 44(1), 4-19.

Clinical Excellence Commission. (2013). General Principles and Requirements for Open disclosure. Retrieved from: https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0004/259015/principles_for_open_disclosure.pdf

Clinical Excellence Commission. (2018). Flowchart of the Open Disclosure process. Retrieved from: https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0004/258988/flow-chart-open-disclosure-process.pdf

De Rassenfosse, G.,  Palangkaraya, A.  & Webster, E. (2016). Why do patents facilitate trade in technology? Testing the disclosure and appropriation effects.  Research Policy, 45(7), 1326-1336.

Elwy, A. R., Bokhour, B. G., Maguire, E. M., Wagner, T. H., Asch, S. M., Gifford, A. L. & Jesse, R. L. (2014). Improving healthcare systems’ disclosures of large-scale adverse events: a Department of Veterans Affairs leadership, policymaker, research, and stakeholder partnership. Journal of general internal medicine, 29(4), 895-903.

Gray, E. A., & Thorpe, J. H. (2015). Comparative effectiveness research and big data: balancing potential with legal and ethical considerations. Journal of comparative effectiveness research, 4(1), 61-74.

Hall, M. A., Orentlicher, D., Bobinski, M. A., Bagley, N., & Cohen, I. G. (2018). Health care law and ethics.  Netherlands: Wolters Kluwer Law & Business.

Harrison, R., Birks, Y., Hall, J., Bosanquet, K., Harden, M., & Iedema, R. (2014). The contribution of nurses to incident disclosure: A narrative review. International journal of nursing studies, 51(2), 334-345.

Harrison, R., Walton, M., Manias, E., Mears, S., & Plumb, J. (2017). Patients’ experiences in Australian hospitals: a systematic review of evidence. Australian Health Review, 41(4), 419-435.

Kalra, J. (2016). Medical error disclosure: A point of view.  Pathol Lab Med Open J, 1(1), 1-3.

Koller, D., Rummens, A., Le Pouesard, M., Espin, S., Friedman, J., Coffey, M. & Kenneally, N. (2016). Patient disclosure of medical errors in paediatrics: A systematic literature review.Paediatrics & Child Health, 21(4), 32-38

Lee, M. (2016). On patient safety: Do you say, "I'm sorry" to patients? Clinical Orthopaedics and Related Research, 474(11), 2359-2361.

McLennan, S. R., Diebold, M., Rich, L. E. & Elger, B. S.  (2016). Nurses’ perspectives regarding the disclosure of errors to patients: a qualitative study. International journal of nursing studies, 54, 16-22.

Schünemann, H. J., Al-Ansary, L. A., Forland, F., Kersten, S., Komulainen, J., Kopp, I. B. & Qaseem, A. (2015). Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Annals of internal medicine, 163(7), 548-553.

Shahmirzadi, L., Chao, E. C., Palmaer, E., Parra, M. C., Tang, S., & Gonzalez, K. D. F. (2014). Patient decisions for disclosure of secondary findings among the first 200 individuals undergoing clinical diagnostic exome sequencing.  Genetics in Medicine, 16(5), 395.

Watson, B. M., Angus, D., Gore, L., & Farmer, J. (2015). Communication in open disclosure conversations about adverse events in hospitals. Language & Communication, 41, 57-70.

White, D., Wright, M., Baber, B. & Barrera, A.  (2017). A pilot study evaluating the effectiveness of a medicines education group in a mental health inpatient setting: A UK perspective. Mental Health Clinician, 7(3), 116-123.

Wong, C. H., Tan, T. R., Heng, H. Y., Ramesh, T., Ting, P. W., Lee, W. S. & Kee, K.  (2016). Parental preferences with regards to disclosure following adverse events occurring in relation to medication use or diagnosis in the care of their children–perspectives from Malaysia. Med J Malaysia, 71(4), 187.

Yeowell, G., Rooney, J. & Goodwin, P. C. (2018). Exploring the disclosure decisions made by physiotherapists with a specific learning difficulty. Physiotherapy, 104(2), 203-208.