Open Disclosure of Adverse Events: Bridging the Gap Between Policy and Practice

Why It Matters

Understanding the challenges in implementing open disclosure is crucial for designing effective communication strategies and support systems in healthcare. This research highlights the need for user-centred approaches that consider the perspectives of all stakeholders involved in adverse event reporting and resolution.

Key Finding

Despite policies promoting open disclosure of adverse events, their implementation in the UK healthcare system faces significant practical challenges. The existing evidence base is limited, and current practices are often driven by expert opinion rather than proven effectiveness, indicating a gap between policy intentions and real-world application.

Key Findings

• A large body of literature exists on open disclosure, but often from conflicting perspectives.
• Current practice is largely based on expert consensus rather than empirical evidence.
• There is little evidence for the effectiveness of disclosure alone or interventions to promote it.
• A tension exists between pragmatic guidance and deeper critiques of transparency in healthcare.

Research Evidence

Aim: To critically evaluate and extend the evidence base for open disclosure of adverse events in the UK's National Health Service (NHS) to support policy implementation.

Method: Mixed-methods research, including systematic literature reviews and qualitative stakeholder interviews.

Procedure: The research involved two systematic literature reviews to summarise empirical research on interventions to enhance open disclosure and to review current opinion and practice. This was followed by primary qualitative research involving interviews with UK-based stakeholders to understand their views and experiences of open disclosure. Findings were synthesized to develop pragmatic suggestions for NHS trust management.

Sample Size: 610 papers for the broad review; 11 papers for the focused review. Specific number of stakeholder interviews not provided.

Context: Healthcare (NHS in the UK)

Design Principle

Evidence-informed design for complex socio-technical systems requires a deep understanding of stakeholder perspectives and practical implementation challenges.

How to Apply

When designing communication strategies or support tools for adverse event reporting in any high-stakes environment, prioritize user research to understand current practices, identify barriers, and co-create solutions with all involved parties.

Limitations

Limited evidence for the effectiveness of disclosure interventions; reliance on expert consensus for current practices.

Student Guide (IB Design Technology)

Simple Explanation: It's hard to get people to openly talk about mistakes in hospitals, even when there are rules for it. We don't have much proof that the ways we try to get them to talk actually work, and a lot of what happens is just based on what experts think is best.

Why This Matters: This research shows that even with good intentions and policies, design solutions need to be grounded in real-world usability and effectiveness, not just theoretical ideals.

Critical Thinking: How can design interventions bridge the gap between mandated policies for open disclosure and the actual, often hesitant, implementation by healthcare professionals?

IA-Ready Paragraph: This research highlights the significant challenges in implementing open disclosure of adverse events within healthcare systems, noting a substantial gap between policy and actual practice. The study's findings, derived from systematic reviews and qualitative interviews, indicate that current approaches often rely on expert consensus rather than empirical evidence of effectiveness. This underscores the critical need for user-centred design approaches that actively address practical implementation barriers and stakeholder perspectives when developing communication and reporting systems.

Project Tips

• When researching a design problem, look for evidence of what works, not just what people say should work.
• Consider the practical challenges of implementing your design in a real-world setting.

How to Use in IA

• Use this study to justify the need for user research in your design project, especially when dealing with sensitive communication or reporting systems.

Examiner Tips

• Demonstrate an understanding of the gap between policy and practice in your design rationale.

Independent Variable: Implementation of open disclosure policies.

Dependent Variable: Effectiveness of interventions to enhance open disclosure; stakeholder views and experiences.

Controlled Variables: UK National Health Service context.

Strengths

• Combines systematic review with primary qualitative data.
• Focuses on a critical area of healthcare practice.

Critical Questions

• What are the ethical considerations when designing systems for disclosing adverse events?
• How can design foster trust and transparency in situations involving potential harm?

Extended Essay Application

• An Extended Essay could investigate the effectiveness of different communication design strategies in promoting open disclosure in a specific healthcare setting, using qualitative methods to gather stakeholder feedback.

Source

An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration · Health Services and Delivery Research · 2014 · 10.3310/hsdr02200