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From 2010 to 2012, a pilot programme on open disclosure devised by the HSE and State Claims Agency (SCA) took place at the Mater Misericordiae University Hospital (MMUH), Dublin, and Cork University Hospital (CUH). A national policy was published in 2013.
However, “clinical engagement” during the pilot was “hugely challenging”, according to an external evaluation recently published on the HSE website. The concerns appeared to especially relate to doctors.
“The national project leads and pilot leads in CUH and MMUH expressed disappointment in relation to the involvement and leadership from clinicians during the pilot,” stated the report.
“Attempts were made to engage clinicians in multiple ways, through clinical governance meetings, the boards in both hospitals, the consultant body in a medical forum, grand rounds with NCHDs and consultants and awareness-raising in various other forums,” noted the report.
The evaluation found it was important to engage clinicians in various ways, such as through doctors’ meetings, journal clubs, medical forums, engagement with clinical directors and senior managers at executive and board levels, as well as through grand rounds.
Post-pilot, a new clinical directorate structure in both hospitals “helped to bring open disclosure closer to clinicians” and the pilot had led to “a shift in the views and approaches” of clinical leaders.
“For example, the pilot in CUH helped to persuade consultants about the need to have a timely response to disclosure. MMUH cited a case of a consultant who resisted disclosure but was persuaded by the Risk Manager to have a timely and open response on the basis that this would reduce the potential of problems arising for him at a later stage. The consultant in question thanked the Risk Manager for persuading him and recognised the benefits of an early disclosure.”
Sometimes team members disclosed errors to patients because the consultant was unwilling to do so. In one case, a senior nurse spoke of a consultant who was “very guarded” about disclosure after an error was made; however, following discussion in her team it was decided to tell the patient what had happened and “that we were sorry”.
Difficulty releasing staff for training was repeatedly raised during the evaluation.