Response to M.-J. Johnstone "Clinical risk management and the ethics of open disclosure. Part 1. Benefits and risks to patient safety" [Aust. Emerg. Nurs. J. 11 (2008) 88-94]

We are grateful for Megan-Jane Johnstone making a broader readership aware of the open disclosure process. Whilst hindsight is a wonderful thing, we nevertheless take this opportunity to respond to a number of her propositions, if only to bridge the gap between conjecture and what is now rapidly becoming reality. Prior to the introduction when describing what open disclosure is, Johnstone does alert the reader quite rightly to the fact that the open disclosure standard has been piloted nationally. At the time of her writing, a final report on the outcomes of the pilot project was submitted to the Australian Commission on Safety and Quality in Health Care. It is worthwhile to signal the publication of this report, to prepare the reader for the opportunity to temper opinion with fact (see Ref. 1; Final report A National Evaluation of the Open Disclosure Pilot at http://www.health.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-02_PilotNODstd). As that report clarifies (also see Ref. 2), the primary method of data collection was the interview. The total number of interviews conducted was 154. Of these, 131 were conducted with health professionals (24 NSW, 29 SA, 33 VIC, and 68 QLD) and 15 were conducted with patients and 8 with (unrelated to these patients except one) family members. All interview sessions were audio-taped and transcribed, resulting in just under 2000 pages of data. Within the limits of the patient group sample size, we believe that this is in fact the robust empirical research Johnstone demands. More importantly, the report demonstrates the benefits of open disclosure to those concerned.