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Disclosing Adverse Events to Patients

International Norms and Trends

Wu, Albert W. MD, MPH; McCay, Layla MBChB, MSc, MRCPsych; Levinson, Wendy MD; Iedema, Rick PhD; Wallace, Gordon MD; Boyle, Dennis J. MD; McDonald, Timothy B. MD, JD; Bismark, Marie M. MBChB, LLB, MBHL, MPH; Kraman, Steve S. MD; Forbes, Emma BA; Conway, James B. MS; Gallagher, Thomas H. MD

doi: 10.1097/PTS.0000000000000107
Original Articles

Objectives There is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of this expectation.

Methods We reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosure: the United States, the United Kingdom, Canada, New Zealand, and Australia.

Results We identified 5 themes that reflect key challenges to disclosure: (1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure.

Conclusions Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.

From the *Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; †Global Alliance for Improved Nutrition (GAIN), Washington, DC; ‡University of Toronto, Toronto, Ontario, Canada; §University of Technology, Sydney, Australia; ∥Canadian Medical Protective Association (CMPA), Ottawa, Ontario, Canada; ¶University of Colorado, Denver, Colorado; #University of Illinois College of Medicine, Chicago, Illinois; **University of Melbourne, Melbourne, Australia; ††University of Kentucky, Lexington, Kentucky; ‡‡Health Quality & Safety Commission, Wellington, New Zealand; §§Institute for Healthcare Improvement (IHI), Boston, Massachusetts; and ∥∥University of Washington, Seattle, Washington.

Correspondence: Albert W. Wu, MD, MPH, Center for Health Services and Outcomes Research, Johns Hopkins University, 624 N Broadway, Room 653, Baltimore, MD 21205 (e-mail:

The authors disclose no conflict of interest.

Supported in part by the Commonwealth Fund.

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