Over 50% of hospitals in Ireland do not have policies or guidelines in place to promote open disclosure following adverse events, a major Dublin medical negligence conference has been told.

Open disclosure is defined as an open discussion of incidents that result in harm to a patient. This includes expressing regret for what happened, keeping the patient/family informed and taking steps to prevent a recurrence.

However, a conference organised by the groups Action Against Medical Accidents and the Medical Injuries Alliance was told that Irish hospitals were often reluctant for legal, financial, reputational or other reasons to apologise or communicate properly with patients following an adverse event.

This, the conference was told, often leads to lengthy litigation and prolonged stress for victims as well as for hospital staff involved. A system of more open disclosure, on the other hand, would benefit both patients and staff, it was stressed.

The conference was told that a more open policy of candour can actually avoid litigation. In many cases patients felt they had no choice but to litigate because of poor communication from hospitals when things went wrong.

Ann Duffy, Clinical Risk Adviser with the State Claims Agency (SCA) Clinical Indemnity Scheme, said they found that 56% of hospitals did not have any open disclosure policies, procedures or guidelines for staff.

She told the conference that there were signs of a shift in culture in the Irish health system towards more open disclosure. However, she said 'open disclosure is happening, but not enough'.

Ms Duffy said the SCA had found that 56% of hospitals did not have any open disclosure policies, procedures or guidelines for staff. Hospitals cited fear of litigation as the main factor barrier/concern relating to implementing open disclosure.

She said a policy of open disclosure had been piloted at two hospital sites, Cork University and the Mater Hospitals, and specific training for staff had been provided so that they could implement this policy. This initiative was likely to be rolled out in other hospitals, she said.

In addition,a national guidance policy on open disclosure would be launched later this month, and the regulatory body for nurses was including open disclosure in its code of practice.

Ms Duffy said legal protection for staff on open disclosure and apologising when adverse incident occur was expected to be dealt with in forthcoming health information legislation.

The SCA had, Ms Duffy said, surveyed patients on their experiences of dealing with hospitals when adverse events occurred, and found that as far as the patients were concerned, it was not always about seeking monetary compensation.

One woman said she had consulted lawyers as the hospital had never acknowledged the two serious incidents that had led to her husband's death. She said she felt the hospital thought that offering compensation without giving any explanation about what happened would make it ok.

Another patient surveyed said they were forced to take legal action as it was felt to be the only option open to them.

Ms Duffy said it was important that patients and families were sufficiently informed and apologised to within 48 hours after adverse events occurred.

Dr Timothy McDonald, Chief Safety and Risk Officer for Health Affairs at the University of Illinois, Chicago, outlined the 'Seven Pillars' response to clinical incidents implemented in his hospital and which is now being rolled out elsewhere in the US.

This system has at its core a duty of candour and communication on hospital staff, as well as an emphasis on process and performance improvement and staff education. The system emphasises full disclosure with a rapid apology and remedy where it is needed.

It also includes supporting the 'second patient' in these incidents, which is the hospital staff.

Dr McDonald stressed that the Seven Pillars Philosophy included financial penalties for failure to comply with full disclosure policy. This, it was suggested at the meeting, would be necessary for such a system to operate successfully in Ireland.

The Seven Pillars system had led to to a 40% to 50% reduction in negligence claims and lawsuits.

Dr McDonald said it had been shown that when information is properly shared with the patient following adverse events, '60%-70% of all lawsuits go away'.

He said things did not go wrong in hospitals because staff were 'bad people.'  Rather, it was often due to factors such as system-induced errors or staff fatigue.

Dr McDonald said doctors who were poor communicators were far more likely to be sued.

Economist Moore McDowell told the conference that the economically rational and avoidable level of healthcare accident-related costs arising in the HSE sector alone was of the order of €250 million to €400 million.

Deirdre Courtney, whose daughter Brid suffered brain damage due to alleged negligence at her birth, told the conference that had their been a duty of candour  and if those involved admitted early on a mistake had been made, her case could have been dealt with more quickly and at far less expense.

Last year, a settlement of €11 million was agreed in this case without admission of liability.

Deirdre said her family had been fought by the HSE every step of the way over an eight year period.

"There is a better way, a more humane way. The patient is not the enemy."