Risk and Clinical Incident Disclosure: Navigating between Morality and Liability

Abstract

In recent years, healthcare incident disclosure has gained increased attention from policy makers, academics, insurers, clinical professionals, patients and consumer groups and lawyers (Australian Commission on Safety & Quality in Health Care, 2013; Clinton & Obama, 2006; Lamo, 2011; Levinson & Pizzo, 2011; Sage et al., 2014; Studdert & Richardson, 2010; Wojcieszak, Banja, & Houk, 2006). Variously described as a form of restorative justice (Berlinger, 2005), a feasible financial risk reduction strategy (Kachalia et al., 2010) and a service responsiveness philosophy (Iedema & Allen, 2012), incident disclosure appears sufficiently flexible to accommodate stakeholders' different and often competing interests. The institutional and personal benefits of incident disclosure have now been widely reported (Boothman, Blackwell, Campbell, Commiskey, & Anderson, 2009; Kachalia et al., 2010). To facilitate and support incident disclosure, there has been much progress in legal reform (Mastroianni, Mello, Sommer, Hardy, & Gallagher, 2010), policy development (Australian Commission on Safety & Quality in Health Care, 2013; Canadian Patient Safety Institute, 2011; U.K. National Patient Safety Agency, 2009), and incident disclosure research (O'Connor, Coates, Yardley, & Wu, 2010) internationally. There have also been consistent efforts to develop targeted training (Iedema, Jorm, Wakefield, Ryan, & Dunn, 2009), procedures (Australian Commission on Safety & Quality in Health Care, 2013), models (Boothman et al., 2009), and detailed advice for policy and law makers about how to further strengthen the practice of disclosure (Sage et al., 2014).