Aged Care Essentials | The ‘Open Disclosure’ Process Explained

The Aged Care Quality Standards require aged care providers to have systems in place that support an ‘Open Disclosure’ process when something has gone wrong that has caused harm, or potential harm, to a consumer. The Aged Care Quality and Safety Commission (the Commission) explains what Open Disclosure means in its 44-page Open Disclosure: Framework and Guidance (the Guidance). But if you don’t have time to read the whole guide, or need a quick overview before diving in, here is Open Disclosure Explained in Five Points.

1. What is Open Disclosure?

According to the Commission, Open Disclosure is “the open discussion that an aged care provider has with people receiving aged care services when something goes wrong that has harmed or had the potential to cause harm to a person receiving aged care service.”

Open Disclosure involves communicating with consumers and others about what went wrong, what you’re doing to fix it, and what you’re doing to make sure it doesn’t happen again.

Standard 6 (Complaints Handling) and Standard 8 (Organisational Governance) of the Aged Care Quality Standards expressly require aged care providers to use Open Disclosure.

2. When should Open Disclosure be used?

The Commission advises aged care providers to “practise Open Disclosure when something has gone wrong that has caused harm 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.”

According to the Commission, examples of situations when Open Disclosure should be used include:

• a provider fails to prevent the spread of infection
• a staff member uses abusive language towards a consumer
• a consumer experiences pressure injury as a result of being left in their bed for too long
• a provider fails to provide meals that meet the cultural preferences of a consumer.

The Commission’s guidance and examples apply exclusively to situations where consumers have been harmed. It is not clear whether the Commission expects providers to practise Open Disclosure where an incident has caused harm to someone other than a consumer, such as a staff member or a member of the consumer’s family.

3. How do we use Open Disclosure?

The Guidance sets out this five-step process for using Open Disclosure:

1. Identify when things go wrong: there are many ways to identify incidents, including internal complaints processes, incident reports, complaints and external assessments.
2. Address immediate needs and provide support: support includes practical and emotional support. This may involve providing clinical care within the service, bringing in health professionals from outside the service, providing translation services and hearing support, and contacting family and carers.
3. Acknowledge and apologise or express regret: according to the Commission, acknowledgements and apologies are not about blame and should be made even if the issue was “no one’s fault.” The Commission advises providers to offer, as early as possible, “a sincere and unprompted apology or expression of regret for harm or grievance caused. An apology or expression of regret should include the words ‘I am sorry’ or ‘we are sorry’.”
4. Find out and explain what happened: this is not just about collecting factual information – it’s also about giving the consumer a chance to tell their story.
5. Learn from the experience and make improvements: this stage involves analysing the information gathered during the Open Disclosure process, using it to improve services and communicating these improvements to consumers and their representatives.

The Commission advises providers to respect consumers’ privacy and cultural needs when implementing these five steps.

4. How do we demonstrate that we use Open Disclosure?

When the Commission assesses your service, you may be asked to demonstrate that you have effective Open Disclosure policies and practices in place.

Demonstrating Open Disclosure is not the same thing as using it. Even if you have a great policy and implement it effectively, there are some things you should do to ensure that you gather enough evidence to prove that you’ve done the right thing:

• Publish your Open Disclosure policy: share it with consumers, ask for their feedback and revise accordingly.
• Record each stage of the process: record the incident, record what staff say to the consumer about the incident, record what the consumer says to staff. Be sure to record your acknowledgement/apology.
• Record what you’ve done to ensure the consumer understands each stage of the process: if you provided translation or hearing services or contacted the consumer’s family, record it.
• Use the outcomes of the Open Disclosure process to update your Plan for Continuous Improvement: it’s not enough to show that you apologised to the consumer and fixed the problem – the Commission’s assessors will want to see that you’re taking steps to ensure the problem doesn’t happen again. Make note of any changes you need to make and record them in your Plan for Continuous Improvement. If no changes are necessary, record that too.
  
  

  5. How do we embed Open Disclosure within our organisation?

It is easy to become overwhelmed by the requirements of Open Disclosure, seeing them as yet another regulatory burden. However, like any tool, if used well, Open Disclosure can actually reduce your regulatory workload and leave your staff with more time and patience to deal with consumers and their complaints.

The secret is to transfer the heavy burden of regulatory work out of heads and into systems. This involves building comprehensive, easy-to-use complaints handling policies, procedures and training programs that simplify the tasks that must be done by staff and outsource and automate everything else.

In many ways, the Open Disclosure process is just a codification of common decency: listen to what people say, acknowledge the harm and try to do better next time. Ironically, this is exactly what aged care staff would consistently and naturally do if their reserves of time, energy and patience weren’t already depleted by the burdens of dealing with complex regulation. It follows that the real value of a good complaints management system is that it empowers aged care staff to do what they’re naturally good at: caring for consumers.