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MBA621 Healthcare Systems Question: Why does the issue exist/how did the issue originate What is the situation that causes it to surface or be elevated now What are the impacts of the issue Who is impacted by it What is the local, national or global significance What are the arguments in support of and in opposition to the issue What work has been undertaken around the issue and what are the results What constraints exist that limit the range of alternatives to addressing the issue What are the risks or ramifications of not resolving or ignoring the issue. Answer: Hospital, where the main aim was to disclose the reason for harm to the patient. The outcomes were positive which lead to the formation of Open disclosure policy (Watson et al, 2015). Open disclosure had been adopted by a number of nations like Australia, Canada, New Zealand and United Kingdom. The open disclosure standards were endorsed by the government of Australia in the year 2003, which was the first national open disclosure policy (Watson et al, 2015). Open disclosure policy may be defined as the open discussion of the adverse events that may harm a patient while receiving the health care with the patient, carers and the family. The open disclosure standard was a disclosure on part of the Australian council for health and safety in Health care (Eaves-Leanos & Dunn, 2012). The main aim of this standard was to promote a transparent and a consistent approach by the organizations for open communications with the patients and their nominated person following an adverse event. One of the main aims of this policy is to mitigate the risks of adverse events by using the information to improve clinical setting and promote a culture focusing on health care safety. The Main Elements Of The Open Disclosure Are:- Apology including words of sympathy and anticipation like ‘We are sorry” or ‘I am sorry’. A valid and factual explanation of the event. Discussion regarding the potential consequences of the adverse events (McLennan & Truog, 2013).. Open disclosure can have a significant effect in the healing and restoration of trusts if the harm is acknowledged. Patient may undergo through physical and emotional trauma following an adverse event, which may affect his or family and carers as well (Eaves-Leanos & Dunn, 2012). Open disclosure helps to lift the burden form the patient or the family’s shoulder. According to Finlay et al.,(2013), when health plan does not go accordingly, patients wants to know what happened and the reason. They try to understand whether there is any genuine regret for the wrong and whether any further action had been taken or not to minimize the risk (McLennan & Truog, 2013). For a clinician it can be utterly confusing whether to disclose the information when an adverse event had occurred. It has to be kept in mind that participation in open disclosure does not breach the standards of professional conduct or the institutional insurance (Guillod, 2013). The open disclosure is an accrediting step in the National Safety and Quality Health Service Standards (NSQHS Standards). OD had been included in the Australian doctor’s code of conduct. This policy had been consolidated in various parts of Australia. The open disclosure policy has been accepted by a number of health care settings, such as the New South Wales Clinical Excellence Commission the Queensland’s Health Quality and Complaints Commission (Department of Health and Human service, 2015).  The royal Australasian college of surgeons has accepted the open disclosure policies and has adopted the policies actively (Australian Commission on Safety and Quality in Healthcare, 2012).  Although the apology law varies from state to territories, the main is to adopt the method of open disclosure. The laws of apology are different in different states as provided in the appendix (appendix 1). For example, the open disclosure comes under the civil liability act in Tasmania, and it comes under wrong’s act in Victoria. Patients value apologies and expressions of empathy, remorse and caring (Australian Commission on Safety and Quality in Healthcare, 2012). Reports suggest that immediate disclosure of medical error could create an environment where the communication is repeated and can accommodate the shifting perspective of those who have experienced the mistake. The undertaking of the O.D policies in Australia has reduced the number of cases of patient harm. People have provided with feedbacks, which O.D makes it easier to prepare themselves for future adverse consequences (Department of Health and Human service, 2015). Breaching of the open disclosure procedures would break the trust between the client and the caregivers. In that case clients can take legal steps against the organization or the client might get into an emotional turmoil. Options and/or Recommendations: It is necessary to make OD a routine part of the medical practice. The OD should be supported by strong federal laws, such that exploitations do not occur with the OD information (McLennan & Truog, 2013). As far as federal laws are concerned the health care professionals were often concerned about the fact that the information about the adverse event should be used against them in medico-legal proceedings. Hence, the OD should be supported by a strong legal frame work of apology laws, state and federal laws (Finlay et al., 2013). To follow a ‘ No- blame’ approach. The clinical staffs should be acquainted with the open disclosure procedure. Dissemination of the initiative can be made through meetings, workshops, publishing of relevant newsletters and posters. Institutions not adhering to the protocol should be penalized (Finlay et al., 2013). It is necessary to inform the patients regarding the support that he would get post any adverse event (Piper et al., 2014). Suitable compensations against any adverse event depending upon the severity of the event. In accordance to this, it is essential to have a prior word with the health insurance organizations and the legal counsel (McLennan & Truog, 2013). Keeping an electronic record of all the sentinel events, in order to tally them with the prior records. To maintain a checklist, in order to avoid the adverse situations. The patients should be informed about the OD policies by letters or personal calls or patient- family brochures (Guillod, 2013). Proper e- learning packages for the open disclosure procedure. A resource toolkit for the health services, including a staff questionnaire. In order to check the implementation of the policy it is essential to obtain feedback from patients and families and preserve the documents for future evaluation. Things To Be Kept In Mind While Interacting With The Patient:- While communicating with the patient, it is necessary to be sensitive to the culture, language and the communication requirement of the patient (Guillod, 2013). The information regarding the adverse event should be given in private, confidential space, away from the clinical area, in a manner that would empower patient and the family (Eaves-Leanos & Dunn, 2012). The clinicians should be extremely aware of the words chosen for disseminating the information. Medical terminologies and jargon should be avoided. It should be ensured that the discussion is not interrupted. Risks Health care professionals were often concerned about the fact that the information about the adverse event should be used against them in medico legal proceedings.  A clinician is often plagued with the fear of losing their job, loss of respect, involvement in a lawsuit, loss of the professional license (McLennan & Truog, 2013). The health care professional can be judged after returning to the work. A patient might get angry or traumatized by the information of the error on doctor’s part.  Hence, the OD should be supported by a strong legal frame work of apology laws, state and federal laws (McLennan & Truog, 2013). Health professionals frequently argue that the legal provisions become burdensome to them and thus should be replaced by some professional guidelines. Whereas most of the researchers argue that the patient safety can be brought by the tort system. Considering the financial implication of the policy, medical errors can increase the compensatory burden on the health care setting. System changes can be implemented in a relatively short time frame but cultural transformation would comparatively take a longer time frame.The managers, operational heads, the doctors, clinical staffs and the legal aspects would be responsible for disclosing the errors. Leadership It is necessary to enlist a clinical leader who will be leading the open disclosure method. It is important to have an explicit and vocal support from the executive and the senior leaderships of the organization (Wu et al., 2013). Managers would be able to analyze and train the clinicians. Support  Other clinical staffs will provide support to the one disclosing the medical error. The deploying open disclosure and legal experts will assure and assists the staffs. Enlistment Of Patients  According to Bismark et al., (2013), successes have been obtained when the patient is asked to become the part of the solution. The clinical staffs would make list of patients on whom the policy has to be implemented, in order to take precautions beforehand. Training And Development A small cohort of clinical staffs should be trained as experts, who can take the responsibility of supporting the other staffs during the open disclosure. Presentation Of A Clear Rationale And Dispelling Of The Myths  The clinicians should dispel the myths regarding open disclosure (like it increases litigation).It is essential to set a target time frame for the work to be implemented. This initiative should not take more than 6 months. Evaluation After the completion of the open disclosure procedure, the participants should be given the opportunity to give feedback. Quarterly audits should be made.  Face to face interviews, patient safety and staff template can be used. The aggregate results can be given for tracking the process over time (Eaves-Leanos & Dunn, 2012).  The reduction in current cases of adverse events as compared to the previous years will be the criteria of resolving the issue. Communication The federal government can take the help of media, news bulletins to disseminate the policies among the different health care settings. It is necessary to provide a detailed description of the policies and the laws involved, including the tort laws and the penalties (Watson et al., 2015). The recommendations have to be communicated to the doctors and the clinical staffs. The communication plan has to be approved by the organizational heads (Watson et al.,2015). The method of communication that can be used in this process includes meetings, telephone calls, memos, emails, newsletters. A clear communication with the stakeholders is necessary to implement open disclosure in a clinical setting. According to Watson et al.,(2015), the executive sponsor, the open disclosure support staffs, patient safety manager and senior clinicians should take active participation in the dissemination process. References Australian Commission on Safety and Quality in Healthcare, (2012).Open Disclosure          Standard Review Report, Sydney, Australia. Bismark, M. M., Walter, S. J., & Studdert, D. M. (2013). The role of boards in clinical governance: activities and attitudes among members of public health service boards in Victoria. Australian Health Review, 37(5), 682-687. Department of Health and Human services. (2015). Open disclosure following adverse events in Victorian health services. [online] Available at: Eaves-Leanos, A., & Dunn, E. J. (2012). Open disclosure of adverse events: transparency and safety in health care. Surgical Clinics of North America, 92(1), 163-177. Finlay, A. J., Stewart, C. L., & Parker, M. (2013). Open disclosure: ethical, professional and legal obligations, and the way forward for regulation. The Medical Journal of Australia, 198(8), 445-448. doi: 10.5694/mja12.10734 Guillod, O. (2013). Medical error disclosure and patient safety: legal aspects. Journal of public health research, 2(3).  doi:  10.4081/jphr.2013.e31 McLennan, S. R., & Truog, R. D. (2013). Apology laws and open disclosure. The Medical Journal of Australia, 198(8), 411-412. doi: 10.5694/mja12.11339 Piper, D., Iedema, R., & Bower, K. (2014). Rural patients’ experiences of the open disclosure of adverse events. Australian journal of rural health, 22(4), 197-203. DOI: 10.1111/ajr.12124 Watson, B. M., Angus, D., Gore, L., & Farmer, J. (2015). Communication in open disclosure conversations about adverse events in hospitals. Language & Communication, 41(Mar), 57-70. doi:10.1016/j.langcom.2014.10.013 Wu, A. W., Boyle, D. J., Wallace, G., & Mazor, K. M. (2013). Disclosure of adverse events in the United States and Canada: an update, and a proposed framework for improvement. Journal of public health research, 2(3).

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