Professor Debora Picone AM Chief Executive Officer Australian Commission on Safety and Quality in Health Care GPO Box 5480 SYDNEY NSW 2001 Dear Professor Picone Review of the national Open Disclosure Standard Thank you for your letter of 31 May 2012 inviting the National Lead Clinicians Group (LCG) to take part in the review of the national Open Disclosure Standard (the Standard) being undertaken by the Australian Commission on Safety and Quality in Health Care (the Commission). On behalf of the Members of the National LCG, I would like to thank you for this opportunity to provide input into the review. Comment on the Standard has now been sought, and in general, the responding Members were supportive of the proposed Standard and we congratulate you on the work undertaken so far. However, a suggestion was put forward with respect to Principle 3: Expression of Regret. Given the difficult line between expressing a genuine „sorry‟, while avoiding implied culpability, it was felt that there could be benefit in some expansion on what might constitute a genuine apology, and perhaps some examples offered as a guide. For your information I have also attached an item about a project being undertaken on „Open Disclosure‟ in WA, which may be of interest to you. I look forward to seeing the outcomes of the review and wish you every success in the process. Yours sincerely
Adjunct Professor Russell Stitz AM RFD Chair National Lead Clinicians Group 22 August 2012 Encl. ATTACHMENT A – Abstract: Interval Cancers the Principle of Open Disclosure
ATTACHMENT A
ABSTRACT Interval Cancers the Principle of Open Disclosure 1 1,2 C. Saunders and E. Wylie 1 School of Surgery, University Western Australia 2 BreastScreen WA, Perth, Australia Introduction: An interval cancer is a cancer that becomes clinically evident after a normal screening episode prior to the next screening examination being due. Review of interval cancers is essential quality improvement activity for the Quality Improvement Committee of BreastScreen WA, and is protected by clinical privilege. BreastScreen WA ensures women are aware of the fallibility of screening mammograms. All women sign a consent form acknowledging that screening mammography can only detect 90% of breast cancers and result letters emphasize this and suggest women must seek medical attention immediately if they note any new symptoms. However it can be very upsetting for a woman to receive a re-invitation for a screening mammogram after she has developed an interval cancer. Often a woman receives the re-invitation while she is still receiving chemotherapy or radiotherapy for her interval cancer. BreastScreen WA have undertaken to communicate to women after a diagnosis of an interval cancer outside the screening programme. Methods: As a process of continuity of care rather than classical open disclosure, BreastScreen WA has commenced writing to clients when the service becomes aware of an interval cancer. The purpose of the letter is to acknowledge that the client has an interval cancer, and to assure the client that their last examination with BreastScreen WA will be reviewed by the service to ensure BreastScreen WA maintains the highest technical standards and quality assurances standards. The letter has been composed by the Western Australian Crown Solicitor‟s Office, and while the letter includes an expression of regret, the letter does not contain an acknowledgment of fault by the service. The client letter contains a return postage paid envelope, and “our commitment to you” client satisfaction pamphlet for client feedback. The letter offers clients‟ the opportunity to make an appointment with the Medical Director if they would like to discuss any aspect of the service. Results: To date, the letter has been well received by the clients‟ with many returning the “our commitment to you pamphlet”. A number of clients‟ have telephoned the Medical Director to discuss their personal diagnosis circumstances. Moreover a large percentage of these women have chosen to return to the BreastScreen WA programme for breast surveillance after the interval cancer. Conclusions: Communicating our acknowledgment that a woman has been diagnosed with an interval cancer and explaining how we use this information to improve standards appears to be well received by women who develop interval breast cancers and has not resulted in any legal action against BreastScreen WA.
