Harrison Reema, Walton Merrilyn, Smith-Merry Jennifer, Manias Elizabeth, Iedema Rick
Faculty of Medicine, School of Public Health and Community Medicine, UNSW, Sydney, NSW, Australia,
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Risk Manag Healthc Policy. 2019 Jan 23;12:5-12. doi: 10.2147/RMHP.S180359. eCollection 2019.
The aim of this study was to explore the service and policy structures that impact open disclosure (OD) practices in New South Wales (NSW), Australia.
An explorative study using semi-structured interviews was undertaken with 12 individuals closely involved in the implementation of OD in hospitals at policy or practice levels within the state of NSW, Australia. Interviews explored the service and policy structures surrounding OD and the perceived impact of these on the implementation of the OD policy. These data were thematically analyzed to understand the factors facilitating and creating barriers to openness after adverse events.
The data identified three key areas in which greater alignment between OD policy and the wider service and policy structures may enhance the implementation of OD practice: 1) alignment between OD and root cause analysis processes, 2) holistic training that links to other relevant processes such as communicating bad news, risk management, and professional regulation and insurance, and 3) policy clarification regarding the disclosure of incidents that result in no or low-level harm.
Evidence from this study indicates that formal OD processes are not routinely applied after adverse events in NSW, despite clear guidelines for OD. The reasons for this are unclear as the service-level and policy-level phenomena that support or hinder OD are understudied. This knowledge is critical to addressing the policy-practice gap. Our paper provides insights regarding the influence of current service-level and policy-level phenomena on the delivery of OD and how policy clarification may contribute to addressing some of the challenges for implementing OD policy. The principles of virtue ethics - specifically, openness and the involvement of service users - may contribute to progressing in this area.
本研究旨在探索影响澳大利亚新南威尔士州（NSW）公开披露（OD）实践的服务和政策结构。
采用半结构化访谈进行了一项探索性研究，访谈对象为12位在澳大利亚新南威尔士州政策或实践层面密切参与医院OD实施工作的人员。访谈探讨了围绕OD的服务和政策结构以及这些结构对OD政策实施的感知影响。对这些数据进行了主题分析，以了解不良事件后促进和阻碍公开的因素。
数据确定了OD政策与更广泛的服务和政策结构之间更大程度的协调一致可能会加强OD实践实施的三个关键领域：1）OD与根本原因分析流程之间的协调一致；2）与其他相关流程（如告知坏消息、风险管理以及专业监管和保险）相联系的全面培训；3）关于披露未造成伤害或造成低级别伤害事件的政策澄清。
本研究的证据表明，尽管有明确的OD指南，但在新南威尔士州，不良事件后并未常规应用正式的OD流程。其原因尚不清楚，因为支持或阻碍OD的服务层面和政策层面现象未得到充分研究。这些知识对于弥合政策与实践之间的差距至关重要。我们的论文提供了有关当前服务层面和政策层面现象对OD实施的影响以及政策澄清可能如何有助于应对实施OD政策的一些挑战的见解。美德伦理学原则——特别是公开性和服务使用者的参与——可能有助于在这一领域取得进展。
