Being Open/Duty of Candour

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Saying sorry when things go wrong

Being open at a glance

The effects of harming a patient can be widespread. Patient safety incidents can have devastating emotional and physical consequences for patients, their families and carers, and can be distressing for the professionals involved.

Being open about what happened and discussing patient safety incidents promptly, fully and compassionately can help patients and professionals to cope better with the after- effects1. Openness and honesty can also help to prevent such events becoming formal complaints and litigation claims.

What does Being open mean? Being open involves:

  • acknowledging, apologising and explaining when things go wrong;
  • conducting a thorough investigation into the incident and reassuring patients, their families and carers that lessons learned will help prevent the incident recurring;
  • providing support for those involved to cope with the physical and psychological consequences of what happened.It is important to remember that saying sorry is not an admission of liability and is the right thing to do.The principlesThe following set of principlesi has been developed to help healthcare organisations create and embed a culture of Being open:
  1. Acknowledgement
  2. Truthfulness, timeliness and clarity of communication
  3. Apology
  4. Recognising patient and carer expectations
  5. Professional support
  6. Risk management and systems improvement
  7. Multidisciplinary responsibility
  8. Clinical governance
  9. Confidentiality
  10. Continuity of care

The process

Being open about a patient safety incident is more than a one-off event; it is a communication process with a number of stages, as outlined below.

The duration of the process will depend on the incident, the needs of the patient, their family and carers, and how the investigation into the incident progresses.

Implementing Being open

The National Patient Safety Agency (NPSA) has developed this updated framework to demonstrate how to strengthen the culture of Being open within healthcare organisations.

This framework provides best practice guidance on how to create an open and honest environment through:

  • aligning with the Seven steps to patient safety3;
  • ensuring a Being open policy is developed that clearly describes the process to be followed when harm occurs;
  • committing publicly to Being open at board and senior management level;
  • identifying senior clinical counsellors to mentor and support fellow healthcare professionals involved in incidents.Boards and senior managers within all healthcare organisations have a crucial role in ensuring
    the Being open framework and principles are embedded.

Being open: saying sorry when things go wrong

Overview of the Being open process

Incident detection or recognition

Preliminary team discussion

Initial Being open discussion

Follow-up discussions

Process completion

Detection and notification through appropriate systems

Initial assessment

Verbal and written apology

Provide update on known facts at regular intervals

Discuss findings of investigation and analysis

Inform on continuity of care

Provide known facts to date

Establish timeline

Share summary with relevant people

Prompt and appropriate clinical care to prevent further harm

Offer practical and emotional support

Respond to queries

Monitor how action plan is implemented

Choose who will lead communication

Identify next steps for keeping informed

Communicate learning with staff


Provide written records of all Being open discussions

Record investigation and analysis related to incident

Committing to Being open will help create an environment where;

  • patients, their families and carers receive
    the information they need to understand what happened, and the reassurance that everything possible will be done to ensure that a similar type of incident does not recur
  • patients, their families and carers, healthcare professionals and managers all feel supported when things go wrong

Supporting information and tools

In addition to this framework, supporting
tools have been developed to assist healthcare organisations with implementing the actions
of the NPSA’s Being open Patient Safety Alert. Training on Being open is freely available through an e-learning tool. Interactive training workshops that use actors and/or video-based materials can also be commissioned by organisations.

Information on all these supporting tools can be found at:

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