Paeds · professional-practice-and-evidence
Open disclosure and duty of candour
Also known as Open disclosure in paediatrics · Duty of candour to children and families · Disclosure of medical error to parents · Patient safety incident disclosure · Being open after harm
Fellowship guide to open disclosure and duty of candour in paediatrics: recognising a notifiable patient safety incident, grading severity, the staged disclosure conversation with apology and expression of regret, adapting disclosure to the child's development and to parents as recipients, the second-victim phenomenon, systemic and cultural barriers, and ANZ/UK/US/Canada frameworks and apology-law differences.
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Red flags
- Concealing or partially disclosing (trickle-disclosing) harm to a child after an incident
- Delaying the initial disclosure until the investigation is fully complete
- Defensive language that distances the team from the harm ('we're sorry this happened to you')
- Withholding a sincere apology for fear it admits legal liability
- Blaming an individual clinician in front of the family
- Leaving the clinician involved in the harm unsupported as a second victim
- Using the child or a family member as interpreter during a disclosure
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Board mappings
- General and Community Paediatrics
- Professional practice and ethics: duty of candour and open disclosure
- Renewed curriculum — Learning goal 12: Communication with patients, families, and health professionals
- Patient safety and quality improvement
- Professional practice, ethics and medico-legal obligations
- Written assessment of professional practice and patient safety
- Communication stations: open disclosure and error conversations
- Structured discussion of duty of candour and the second victim
- Long Cases involving an adverse event
- 2. Professional skills and knowledge: patient safety and quality improvement
- Leadership and team working; just culture
- Safeguarding themes when harm occurs in healthcare
- Foundation of Practice (FOP): patient safety and professionalism
- Applied Knowledge in Practice (AKP): ethics and error disclosure
- Communication: open disclosure and apology to families
- Safe prescribing and patient safety scenario
- General Pediatrics Content Outline — patient safety, quality improvement and professionalism
- Bioethics: disclosure of medical error and duty of candour
- Systems-based practice and just culture
- Systems-Based Practice and Practice-Based Learning: patient safety events and disclosure
- Professionalism: candour and accountability
- Interpersonal and Communication Skills: error disclosure to families
- Communicator: disclose harmful incidents and apologise
- Professional and Scholar: quality improvement and just culture
- Leader: support the second victim and foster a learning culture
- Collaborator: multidisciplinary incident review
Two things that get mixed up
Open disclosure
Duty of candour
Overview & Definition
A 3-year-old on the ward is given ten times the intended dose of an opioid because of a decimal-point error. The nurse realises within minutes, the child is reviewed and is fortunately unaffected, and both parents are at the bedside. What happens in the next hour — what you say, whether you say sorry, whether you are honest about what went wrong — will decide whether this family trusts your team for the rest of their child's care, or leaves feeling deceived. That conversation is open disclosure, and the obligation to have it is the duty of candour. [1] [4]
Open disclosure is the open discussion with a patient, and their family, of a patient safety incident that resulted in harm while they were receiving health care. It is not a confession, a legal admission, or a single scripted speech; it is a staged process of communication that runs in parallel with clinical stabilisation, incident reporting and formal review. The framework was developed and evaluated at national scale in Australia through the Open Disclosure Pilot, which showed that families want the truth, an acknowledgement of harm, an apology, and assurance that the system will learn. [1] [2] [10]
The duty of candour is the obligation behind the process. In paediatrics it carries a particular weight: the patient is a child who may be too young to receive the information directly, so the conversation is usually held with parents or guardians, and the child or young person is brought in developmentally. Harm to a child strikes at the heart of a family's trust in the institution that was meant to protect them, which is exactly why concealment or partial disclosure is so corrosive here. [4] [5]
This page owns the process and obligation of disclosure. Cross-link the dedicated leaves for the recognition and analysis of adverse events, for breaking bad news, for consent and mature-minor frameworks, for communicating risk and uncertainty, for conflict and complaints, and for trauma-informed care — do not rebuild their content here. [6]
References18ShowHide
- [1]Iedema RA The National Open Disclosure Pilot: evaluation of a policy implementation initiative. The Medical journal of Australia, 2008.PMID 18393742
- [2]Iedema R Patients' and family members' experiences of open disclosure following adverse events. International journal for quality in health care, 2008.PMID 18801752
- [3]Gallagher TH US and Canadian physicians' attitudes and experiences regarding disclosing errors to patients. Archives of internal medicine, 2006.PMID 16908793
- [4]Jacob H Openness and honesty when things go wrong: the professional duty of candour (GMC guideline). Archives of disease in childhood. Education and practice edition, 2016.PMID 27002114
- [5]Inkster T Duty of candour and communication during an infection control incident in a paediatric ward of a Scottish hospital. Journal of medical ethics, 2022.PMID 33593873
- [6]Brandom BW What happens when things go wrong? Paediatric anaesthesia, 2011.PMID 21251144
- [7]Aubin J Benefit of Simulation-Based Training in Medical Adverse Events Disclosure in Pediatrics. Pediatric emergency care, 2022.PMID 34398860
- [8]White AA Crowdsourced Feedback to Improve Resident Physician Error Disclosure Skills: A Randomized Clinical Trial. JAMA network open, 2024.PMID 39110461
- [9]Stroud L Teaching medical error disclosure to physicians-in-training: a scoping review. Academic medicine, 2013.PMID 23619064
- [10]Iedema R Practising Open Disclosure: clinical incident communication and systems improvement. Sociology of health & illness, 2009.PMID 18983420
- [11]O'Connor E Disclosure of patient safety incidents: a comprehensive review. International journal for quality in health care, 2010.PMID 20709703
- [12]Perez B Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem. Journal of patient safety, 2014.PMID 24553443
- [13]Varjavand N Changes in intern attitudes toward medical error and disclosure. Medical education, 2012.PMID 22691146
- [14]New L Second-Victim Phenomenon. Nursing clinics of North America, 2024.PMID 38272580
- [15]Smith ML Thinking ethically about medical mistakes. Journal of child neurology, 2013.PMID 23435283
- [16]Case J What Drives Patients' Complaints About Adverse Events in Their Hospital Care? A Data Linkage Study of Australian Adults 45 Years and Older. Journal of patient safety, 2021.PMID 33512865
- [17]Mansour R Disclosure of medical errors: physicians' knowledge, attitudes and practices (KAP) in an oncology center. BMC medical ethics, 2020.PMID 32819353
- [18]Wong BM Learning Through Experience: Influence of Formal and Informal Training on Medical Error Disclosure Skills in Residents. Journal of graduate medical education, 2017.PMID 28261397