Communicating bad news: when care goes wrong

Analyses of medical records, incident reports, observations and interviews have revealed that care may at times go wrong. The frequency of such failures and errors is difficult to establish, mainly due to a lack of reliability of relevant documentation. Errors and failures are not always reported and are not always immediately evident Reported incident rates have varied between 6% and 16% (Wilson et al., 1995), with some commentators putting incident rates as high as 25-30% (Classen et al., 2011). A small proportion of these incidents involve death and permanent disability (Vincent et al., 2008). When a patient experiences harm as a result of an incident, it is now mandatory in most Australian health services that they are told what went wrong and why, a practice referred to as incident disclosure or 'open disclosure'. The policy that mandates incident disclosure is the 'Australian Open Disclosure Framework' (Australian Commission on Safety and Quality in Health Care, 2013).