When an individual receives aged care services, they, along with their families, expect a high standard of attention and safety. Unfortunately, mistakes can happen in any service environment. In aged care, when something goes wrong that causes harm or has the potential to cause harm, the way a provider communicates is essential to maintaining trust and meeting quality standards. This communication process is known as Open Disclosure.

Understanding Open Disclosure

Open disclosure is a formal, honest, and respectful discussion between an aged care provider and the person receiving care (or their family/representatives) following an adverse incident. It is about transparency—being open about what happened, what is being done to manage the consequences, and what steps are being taken to prevent recurrence.

This process moves beyond a simple acknowledgment of an issue. It is a mandated part of aged care quality in Australia. Under the Aged Care Quality Standards, specifically Standard 6 (Feedback and Complaints), providers are required to use an open disclosure process when things go wrong.

The foundation of Open Disclosure rests on the idea that people have a right to know what has happened to them. When providers are open, they demonstrate respect for consumer rights and actively work toward rebuilding confidence.

The Core Elements of Effective Open Disclosure

For an open disclosure conversation to be effective and meet regulatory requirements, it must contain several key components. These elements structure the discussion and guide the provider in delivering a message that is both honest and supportive.

1. An Apology or Expression of Regret: This is often the most significant component for families. The apology should be clear and straightforward, including words like "I am sorry" or "we are sorry." Providing an apology is not an admission of legal liability; rather, it is a human acknowledgment of the distress or harm caused by the incident. It shows genuine concern and empathy.
2. A Factual Explanation of What Happened: The discussion must include a truthful account of the event based on the information known at the time. This should describe the incident clearly, avoiding jargon and technical language. Providers should present facts, not conjecture, and explain the steps taken immediately after the incident.
3. An Opportunity for the Patient/Family to Share Their Experience: The discussion should be a two-way conversation. The provider must dedicate time for the person receiving care, their family, and carers to express their side—their feelings, observations, and how the event impacted them. Listening actively is as important as speaking.
4. A Discussion of Potential Consequences: The provider needs to discuss the known and potential short-term and long-term effects of the adverse event. This includes discussing any required ongoing care or changes to the care plan. This information helps the family understand the gravity of the situation and the path forward.
5. Explanation of Review and Improvement Actions: Crucially, open disclosure involves explaining how the incident will be reviewed. What lessons are being learned? What changes to procedures or systems will be implemented to lessen the chance of this type of event recurring? This demonstrates a commitment to ongoing quality improvement.

Open Disclosure and the Serious Incident Response Scheme (SIRS)

The implementation of Open Disclosure is closely tied to Australia's Serious Incident Response Scheme (SIRS). SIRS mandates reporting and management of serious incidents in aged care homes. When a serious incident occurs that requires reporting under SIRS, Open Disclosure becomes the mechanism for communicating that incident to the residents and their families.

The framework is designed to work together with SIRS. While SIRS focuses on the formal reporting and investigation of specified incidents, Open Disclosure governs the human interaction and communication surrounding that event. A provider cannot meet their SIRS obligations fully without also adhering to the principles of Open Disclosure regarding communication with the affected parties. The process helps explain to a family that something went wrong without necessarily admitting legal liability, focusing instead on maintaining integrity and confidence.

The Challenge of Communication

Talking to families after a serious incident can be difficult, particularly when emotions are high. Staff members involved in the open disclosure process need good communication abilities and organizational support.

Preparation is key. Before the conversation, the provider must gather all the facts, determine who should attend (including a clinical expert and a support person for the family if appropriate), and plan the discussion's structure. The provider must select a time and location that ensures privacy and comfort.

During the conversation, language matters. It is important to use plain, respectful language and to be genuinely empathetic. Providers should be prepared to handle strong emotional responses, allowing silence and space for the family to process the information. If the provider does not have all the answers immediately, they must commit to finding them and establishing a follow-up timeframe.

Benefits of Transparency

Adopting a robust Open Disclosure Framework offers significant benefits for aged care providers.

Firstly, it improves relationships. By choosing honesty and openness, providers show respect. This openness helps preserve the working relationship between the facility and the resident's family, even following a mistake.

Secondly, it contributes to better learning and safety. The framework requires providers to review incidents and apply lessons learned. This leads to changes in procedures, staff education, and systemic improvements that make the care environment safer for everyone.

Thirdly, it meets regulatory standards. As Open Disclosure is a requirement of the Aged Care Quality Standards, its effective use demonstrates compliance and a commitment to quality service delivery.

Finally, while counterintuitive, transparency can actually lessen the likelihood of formal complaints or legal action. Families often pursue formal avenues because they feel ignored, dismissed, or that the truth is being hidden. An honest, timely apology and explanation often satisfy a family’s need for accountability.

Moving Forward with Openness

Implementing effective Open Disclosure requires more than just knowing the policy; it requires a cultural change within the organization. Staff must feel comfortable reporting incidents and participating in open conversations without fear of unfair blame. Training on communication abilities, dealing with grief and anger, and the non-legal implications of an apology is fundamental.

A commitment to openness is a commitment to quality. It is a recognition that true quality care includes how a provider handles situations when care falls short of the desired outcome. For people receiving aged care and their loved ones, Open Disclosure is an affirmation that their rights and well-being are paramount, even in the face of adverse events.

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Frequently Asked Questions (FAQs) About Open Disclosure

Q1: What is the main purpose of Open Disclosure?

A: The main purpose is to have an open, honest discussion with a person receiving aged care (or their family) after an adverse event has caused or could have caused harm. It seeks to maintain trust, explain what happened, apologize for the harm, and discuss steps for improvement.

Q2: Is an apology under Open Disclosure considered an admission of legal liability?

A: No. In the context of aged care quality frameworks, an apology or expression of regret is a humanitarian gesture acknowledging the distress caused. It is not, in itself, an admission of legal fault or liability.

Q3: Is Open Disclosure mandatory in Australian aged care?

A: Yes, it is a mandatory requirement under the Aged Care Quality Standards, specifically Standard 6, relating to Feedback and Complaints.

Q4: Who should conduct the Open Disclosure discussion?

A: The discussion should be conducted by trained staff, typically including a senior manager and potentially a clinical expert who can explain the details of the incident and clinical outcomes. It is generally advisable to have two staff members present.

Q5: How does Open Disclosure relate to the Serious Incident Response Scheme (SIRS)?

A: SIRS is the mandatory reporting and investigation scheme for serious incidents. Open Disclosure is the framework used by the provider to communicate the details and consequences of that incident to the affected resident and their family, working in conjunction with SIRS requirements.

Q6: What if the provider does not have all the answers right away?

A: The provider should still initiate Open Disclosure promptly, offering all known factual information and the apology. If some facts or investigation results are pending, the provider must commit to a clear timeframe for follow-up communication to share the remaining information.

Q7: Should the family bring anyone to the discussion?

A: Yes, the family or representative should be offered the opportunity to bring a support person or advocate to the Open Disclosure discussion.

Q8: What documentation is required for Open Disclosure?

A: Providers are required to document the Open Disclosure process, including when the discussion occurred, who was present, what was discussed, the key points raised by the family, and what follow-up actions were agreed upon. This record is important for showing compliance with quality standards.