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Trusts 'fail on patient openness'

  • 4 Comments

The families of patients who are victim of a “serious incident” at an NHS organisation may be waiting for a year before they are given any explanation, researchers found.

And almost two-fifths of trusts openly discuss incidents with patients and families half or less than half of the time, the study found.

Barriers to openness with patients or their families include fear of blame or litigation or being accused of malpractice and feelings of guilt, according to the research published online in BMJ Quality and Safety.

Some trusts have failed to recognise the importance of openness with patients about mistakes, the authors said.

Trusts should examine the way they manage openness with patients and their families and make sure the appropriate support mechanisms are in place, they added.

The researchers, from Imperial College London, questioned 209 patient safety managers at trusts in England.

They found that almost all were familiar with the National Patient Safety Agency’s Being Open guidance, released in 2005 and again in 2009.

Hospitals were told to be open and truthful about causing harm instead of taking a defensive and legalistic approach.

But 9% of trusts said they did not have a “board-approved” policy on open disclosure.

The researchers also found that disclosure policies were less likely to be implemented when the incident was resolved and the patient made a full recovery.

In two-thirds of trusts the first open disclosure meeting with patients and their families did not happen until three to six months after the trust’s own investigation into the incident, they found.

“A particularly worrying finding is that a high proportion of patient safety managers reported that the first open meeting with patients and families takes place three to six months after the investigation, which itself may have lasted some months,” the authors wrote.

“This implies that many patients and families are waiting up to a year before any clear explanation of serious incidents is given, which is extremely stressful in many cases.

“Patients are in favour of prompt provision of information about things that go wrong in their care and this delay in itself is likely to exacerbate the distress already caused, erode trust and may also increase the likelihood of further complaints and litigation.

“The survey also suggests that there is limited representation of clinical staff in comparison to managers at open disclosure meetings, despite evidence suggesting that patients attach great importance to clinical staff who are involved in patient safety incidents being also involved in the communication of the incidents to the patients.”

The authors concluded: “Our findings suggest that there is high awareness among patient safety managers of the importance of being more open with patients, but that progress is slow and that some trusts have simply failed to recognise the importance of this issue.

“Our findings highlight the need for NHS trusts to look closely into the ways in which they manage the aftermath of patient safety incidents and to ensure that sensitive support mechanisms are in place for patients, families and staff.”

  • 4 Comments

Readers' comments (4)

  • At the root of this issue is the time it takes to investigate and analyse the causality of the incident. It is inevitable some incidents will be lengthy, but not all. Expeditious investigation benefits patients, their relatives and the staff who can correct procedures/behaviours/practices. Feedback is gold dust but does need resources.

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  • I thought that being open following a serious incident was mandatory? Why aren't Trusts complying?????

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  • michael stone

    This is not a surprise to me.

    patrick newman | 2-Oct-2012 12:51 pm

    There is no obvious reason, why patients and relatives cannot be told what is known 'at this time' - you don't need to only tell people at the end of a lengthy investigation, you can keep them informed as it runs !

    I admit it requires some resources - and also a spirit of openess, which is sadly lacking in many cases.

    and re

    “The survey also suggests that there is limited representation of clinical staff in comparison to managers at open disclosure meetings, despite evidence suggesting that patients attach great importance to clinical staff who are involved in patient safety incidents being also involved in the communication of the incidents to the patients.”

    You (P/R) want to talk to the people who were there during the event - the clinicians !

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  • Sadly this doesn't surprise me. Despite requesting an incident be investigated less than a week after experiencing the patient-view of my local hospital, I had no response for 6 months, despite contacting them at the end of each 4 week period (the official response time) to follow-up. When the letter finally came it said that due to the length of time since the incident & impact on staff recollection they were unable to investigate - convenient!!

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