Open disclosure at Mater Health Services Brisbane is recognised as a success story by several bodies including the Australian Commission of Quality and Safety in Health Care. A key component of this success is its partnership with Cognitive Institute.
The development and implementation of open disclosure in a healthcare organisation can be a challenging process.
Each organisation has its own distinctive characteristics and demands that need to be taken into account when developing an open disclosure philosophy, policy and framework, and implementing them in practice.
A collaborative relationship with external open disclosure experts can meet this challenge and help to ensure that these characteristics and demands are accurately assessed, and then integrated in an effective and efficient manner.
In 2004 Mater engaged the open disclosure services of the Cognitive Institute for this purpose, training many senior clinicians in the Institute’s Mastering Open Disclosure workshop as well as implementing the Clinical Incident Management (CIM) programme. The CIM programme advocates for and provides resources to support a coordinated organisational response to the most serious of adverse outcomes. The programme is centred on high-intensity training for a small number of selected senior clinicians in how to effectively ensure an ethical organisational response to serious adverse outcomes and how to support their colleagues in undertaking the often challenging conversations with patients and families after such events.
Recognising the need for professional services
“When Mater adopted open disclosure as a goal in 2004, we recognised we needed outside help,” says Dr Don Cave, gynaecological surgeon and senior medical consultant in clinical risk management at Mater, which has 4,000 clinical staff.
“It was firstly a logistics issue. We didn’t have enough staff sufficiently trained for such an immense programme. But more than this, we needed help with open disclosure knowledge and skills for our specific situation,” says Dr Cave.
Open disclosure was, and is, regarded by Mater as a pillar of patient safety and quality healthcare, which was under the responsibility of its Clinical Safety Quality Unit (CSQU) that had been established in 2003.
“We understood that revealing to the patient and family that an adverse event has occurred was not just an important part of the healing process. It also helps to build trust, and you can’t have safety if patients don’t trust clinical staff,” says Dr Cave.
“However, while there was awareness that open disclosure was the right thing to do among clinical staff, they had never received the training to gain the knowledge and skills for having those sometimes very difficult conversations with a patient and their family,” he says.
Bringing doctors on board
Mater partnered with the Cognitive Institute to help develop and implement open disclosure after having previously engaged with them to implement communications workshops in preceding years.
An important feature for Mater was Cognitive Institute’s ability to help create a supportive environment for clinical staff while developing and implementing open disclosure.
“The process of open disclosure has its challenges as it can be difficult to get to the bottom of an incident, as naturally staff are concerned that their reputation, integrity and career could be jeopardised.
“We saw the benefit of Cognitive Institute’s trainers being experienced clinical doctors. Of course doctors can take the initiative on issues advocating for their patients and communities, however sometimes they need to be brought on board, which can be facilitated better when they are spoken to by another doctor who understands them,” says Dr Cave.
Mater’s open disclosure philosophy, policy and framework, developed together with the Cognitive Institute, were launched in early 2005, followed by the CIM programme.
“Cognitive recommended that they train selected senior staff who would then become a significant resource for all clinical staff at Mater as part of our Clinical Incident Management System (CIM),” says Dr Cave.
“The philosophy behind this recommendation is that from the start there needs to be commitment to the process of open disclosure amongst people at the highest level of the organisation,” he says.
“A crucial aspect of this model has been having these senior staff, who are called CIMs colleagues, available on request to support less experienced or learner clinicians during open disclosure conversations with patients and families when they occur,” he says.
“It is not immodest to claim that open disclosure at Mater has been a success story,” says Dr Cave.
After the open disclosure training had been completed in 2007 and the CIMs support was well established, the number of requests for help to CIMs colleagues quickly began to decline and, as of today, it’s rarely required at the Mater.
“Now clinicians learn on the ground as events occur,” says Dr Cave. “For example, if there’s an adverse event that involves a more senior and experienced doctor, junior staff accompany and witness how that doctor handles the situation and learn from them. Training by the senior staff is usually only needed now for new staff,” he says.
“Examples of external measures of success at the Mater include a state coroner’s inquiry in 2007 that included comments that praised and commended the Mater’s open disclosure practices,” says Dr Cave.
“While insurance premiums are on the increase generally for healthcare providers, we’re confident that these costshave been curbed due to implementing an open disclosure programme. These positive results have been acknowledged by the Health Quality and Complaints Commission in Queensland which has received far fewer enquiries in relation to Mater since the programme was implemented,” he says.
Mater and Cognitive Institute’s open disclosure implementation work has also been recognised as a successful case study by the Australian Commission on Safety and Quality in Health Care.
Mater has continued working with the Cognitive Institute following the development and implementation of open disclosure.
The Speaking Up for Safety programme, which trains staff to be advocates for patient safety and speak up in at-risk situations, was introduced in 2006. Another programme that is currently being implemented aims to reinforce the practice of highly reliable healthcare techniques, from hygiene on hospital wards through to following clinical guidelines.
It is clear that Mater recognises that engaging professional services such as those provided by the Cognitive Institute can lead to ongoing benefits for patient safety and quality healthcare.
About Mater Health Services
Mater Health Services comprises seven hospitals, health centres, a world-class medical research institute, and pathology and pharmacy businesses – all with one aim – to provide exceptional care. Mater provides exceptional care across a broad range of clinical areas with a strong focus on cancer and neuroscience, women’s health and newborn services, and the care of young adults and adolescents.