Open disclosure is the open discussion that Fairlea Aged Care must engage in with consumers when something goes wrong that has harmed, or had the potential to cause harm to, a consumer.
Harm may be physical, psychological or social resulting in loss of quality of life, impairment, suffering, injury, disability or death.
Open disclosure involves:
- Communicating with the consumer when something goes wrong in an open and transparent manner
- Addressing any immediate needs or concerns of the consumer
- Providing practical and emotional support to the consumer, if required
- Acknowledging the wrong and providing an apology or an expression of regret to the consumer
- Investigating the incident and explaining to the consumer what has happened
- Implementing improvements to prevent the issue reoccurring
Open disclosure can also involve the consumer’s family, carers, and representatives which a consumer would like to be involved.
Why We Practise Open Disclosure
Legal Obligation
Practising open disclosure when things go wrong is a requirement of the strengthened Aged Care Quality Standards (Quality Standards) (refer to Standard 2 Outcome 2.3).
We are regularly assessed by the Aged Care Quality and Safety Commission with respect to our compliance with the Quality Standards and during these assessments the Commission will actively seek to understand how we have:
- applied open disclosure in practice
- taken account of best practice guidance
- implemented approaches relevant to the services we deliver
The Commission will actively seek evidence from us that we are practising open disclosure and will consider such evidence as a positive sign that we have effective systems in place to identify and monitor risk and adverse events.
Ethical, Moral and Professional
Honest and timely disclosure to consumers is ethically, morally and professionally expected, and is also the first stage in promoting and fostering an environment and culture that, through open discussion, encourages the learning needed to improve care and services.
Open disclosure underpins our organisational culture and the behaviours needed for continuous learning and service improvement in partnership with our consumers. Ultimately it improves transparency and public trust in aged care services.
The Four Principles of Open Disclosure
The following four principles, linked to the Statement of Aged Care Rights, underpin open disclosure in aged care.
Principle 1: Dignity and Respect
Each consumer has the right to be treated with dignity and respect, to be listened to and understood, and to have their person of choice, including an aged care advocate, support them or speak on their behalf.
This means:
- communicating respectfully and recognising and respecting a consumer’s individuality in all aspects of care and services, particularly with consumers with diverse backgrounds
- providing timely information in a form and language that is understood to help consumers exercise control and make informed choices
- letting consumers know if something goes wrong that may have harmed, or has the potential to harm, them and letting them have a say in addressing the issue
Principle 2: Privacy and Confidentiality
Each consumer has the right to personal privacy and to have their personal information protected.
Privacy laws must be understood and respected by all staff. When something has gone wrong, it is important that we discuss this with the consumer and/or their representative and determine what personal information they are comfortable sharing — and with whom within the facility.
We also need to ensure that if the consumer does not want to be identified and does not grant permission to share specific details, we have a strategy to determine how and what information can be communicated without breaching the consumer’s privacy and confidentiality.
Principle 3: Transparency
Consumers have the right to be informed about their care and services in a way that they understand, to direct their care, and to access all information about themselves.
When harm or potential harm — a ‘near miss’ — has occurred, we must communicate three pieces of information to consumers:
- what happened and what immediate action has been taken to address the harm
- what changes will be made to decrease the likelihood that such an event may happen again
- an apology
Consumers’ trust and confidence in the facility will be eroded if we are slow to respond to an incident or are perceived to be covering up circumstances of actual or potential harm. Failure to apply this principle reduces the likelihood of early resolution and increases the likelihood of escalating complaints.
All Australian jurisdictions have enacted laws that are designed to protect statements of apology or regret made after incidents involving harm or potential harm from subsequent use in legal proceedings.
Principle 4: Continuous Quality Improvement
All aged care providers are required to implement systems and procedures to ensure continuous improvement.
Open disclosure is an important element of our Continuous Improvement Program, as continuous improvement can only occur where an organisation has a culture of learning that places high value on identifying and recording incidents as well as analysing and acting on information once it is received.
The Five Elements of Open Disclosure
These elements are not intended to occur in a particular order, nor will they apply in all circumstances. Variation in how the elements are used is expected and encouraged to allow adaption to specific circumstances.
1. Identify When Things Go Wrong
Open disclosure begins with identifying when something has gone wrong that has harmed a consumer or has the potential to cause harm. Identification can occur through multiple channels including:
- at point of care delivery through observation
- through incident reporting and related risk assessments and complaints
- through established consumer feedback and complaints mechanisms
- through internal self-assessments and audits
- through external reviews
Our Incident Management process has been designed to capture incidents from multiple channels and to apply open disclosure practices where something has gone wrong.
2. Address Immediate Needs and Provide Support
Once we have identified that something has gone wrong, we take immediate action to address actual or potential harm, including ensuring practical and emotional support is provided based on the needs and preferences of the individuals involved.
3. Acknowledge and Apologise, or Express Regret
Acknowledging and apologising or expressing regret when things go wrong is a key element of open disclosure. It is not about saying someone is at fault. Open disclosure may occur over the course of several discussions and the member of the workforce leading the communication should usually be the most senior staff member involved in the care of the consumer.
All Australian jurisdictions have enacted laws that are designed to protect statements of apology or regret made after incidents involving harm or potential harm from subsequent use in legal proceedings.
4. Find Out and Explain What Happened
We gather all necessary information to understand what has happened. The nature and scale of the harm or incident will determine how the inquiry or investigation is carried out.
Key steps for communicating with a consumer include:
- providing a factual explanation of what happened
- offering an opportunity for the consumer to tell their story
- follow-up meetings and support
- maintaining records of conversations and outcomes as appropriate
5. Learn from Experience and Make Improvements
Open disclosure gives us the opportunity to learn and to find and action improvements to our systems, practices and culture. Information gained through practising open disclosure is seen as an opportunity to identify where things have gone wrong and to take positive steps to prevent such incidents from happening again.
How We Enable Open Disclosure
To enable effective open disclosure, Fairlea Aged Care has strong corporate and clinical governance arrangements in place. Systematic action is taken across six key areas.
1. Leadership and Culture
Strong leadership is critical for effective open disclosure. Our leaders are responsible for, and committed to, promoting a culture of safe, inclusive and quality care and services that is embedded in all aspects of organisational life and owned by everyone.
2. Consumer Partnerships
Partnerships with consumers form the foundation for effective open disclosure. Consumer partnerships must be based on mutual trust and respect within a culture that supports open communication and learning.
3. Organisational Systems
A systematic approach is needed to ensure instances of harm, or potential harm, to consumers are consistently identified, and that open disclosure is practised appropriately. This is supported by our Corporate Governance Framework, Clinical Governance Framework, Enterprise Risk Management Program, Compliance Program, Incident Management, Internal Audits and Suitability Assessments, Continuous Improvement Program and Information Management Systems.
4. Monitoring and Reporting
Ongoing monitoring and review processes are important to understand the effectiveness of open disclosure, outcomes for consumers and to identify areas for improvement.
We use our Plan for Continuous Improvement to manage and evidence open disclosure by including the threshold open disclosure question — Has something gone wrong that has harmed, or had the potential to cause harm to, a consumer? — in our Feedback & Complaints form and relevant incident forms. This enables us to report on every open disclosure incident and examine the application of the five elements.
5. Effective Workforce
Effective open disclosure relies on our workforce and, where relevant, visiting practitioners embracing a culture of transparency and continuous improvement where the consumer’s dignity, respect, privacy and confidentiality are paramount.
6. Communication and Relationships
Communication underpins effective open disclosure. Good communication processes — both internal and external — are needed to establish a culture of transparency, partnership and learning that supports open disclosure.
Aged Care Standards and Open Disclosure
The Aged Care Quality Standards (2024) include requirements for Aged Care Providers in relation to open disclosure, predominately in Standards 1, 2 and 3.
| Aged Care Quality Standard | Open Disclosure Requirement |
|---|---|
| Standard 1 The Individual Outcomes 1.1, 1.2 and 1.3 | Providers are required to demonstrate that each consumer is treated with dignity and that their identity, culture and diversity is valued. |
| Standard 2 The Organisation Outcomes 2.3 and 2.6 | Organisations are required to demonstrate that the open disclosure process is implemented when incidents occur (i.e. things go wrong). |
| Standard 2 The Organisation Outcome 2.6 | The provider takes timely action to resolve complaints and uses an open disclosure process when things go wrong. |
| Standard 5 Clinical Care Outcome 5.1 | Organisations are required to demonstrate that they have a clinical governance framework. |
| Standard 5 Clinical Care Outcome 5.5 | Providers are required to demonstrate the effective management of high impact and/or high prevalence risks associated with the individual care of each consumer. |
Mapping of the links between open disclosure and the Aged Care Quality Standards is provided in the Open Disclosure Framework and Guidance (2019) published by the Aged Care Quality and Safety Commission.
Reference: Open Disclosure — Framework and Guidance (Aged Care Quality and Safety Commission)
