Adverse medical outcomes, preventable or otherwise are a reality of medical care. Most importantly, adverse events impact patients – but they also impact healthcare practitioners.
Disclosing information about adverse events has benefits for the patient and the hospital staff and it can often strengthen the patient doctor relationship and promotes trust. Trust is paramount in all workplaces. After an adverse outcome, patients expect and want timely and full disclosure of the event. Acknowledgement of responsibility, understanding of what happened, expressions of sympathy and a discussion of what is being done to prevent re-occurrence.
Many surveys have shown that patients are less likely to pursue litigation if they perceive that the event was honestly disclosed. Barriers to full disclosure on many occasions include fear of retribution for reporting an adverse event, lack of training, a culture of blame and fear of litigation. Often these fears are irrational and not based upon fact. In NSW, Section 69 of the Civil Liability Act 2002 (NSW) specifically prohibits an apology being used to establish fault in court proceedings. Further, evidence of an apology cannot be led in any such proceedings.
Health care facilities (and all workplaces) should establish non punitive and a blame free culture that encourages staff to report adverse events and near misses without fear of retaliation. Written policy should address these issues of management so that trust can be established at all levels in the healthcare system.
Only then will we make our excellent health care system even better.