Open disclosure is no longer just a compliance conversation
It would be easy to treat Australia’s revised Open Disclosure Framework as another governance update or a refreshed policy, with updated resources and another set of expectations for health services to incorporate into their systems. I think that would miss the point.
The 2026 Framework, released by the Australian Commission on Safety and Quality in Health Care, does more than update the 2014 framework. It raises the bar for how healthcare organisations communicate when care does not go to plan, acknowledge harm, listen to patients and families, support staff through difficult conversations, and turn experiences of harm into opportunities for learning and improvement.
As someone supporting healthcare organisations in governance and risk, the message is clear: open disclosure cannot be left to policy alone. It needs to become an organisational capability. That means leaders, clinicians, consumer partners, risk and governance teams, educators and support staff need a shared understanding of what good open disclosure looks and feels like in practice – not simply what a procedure says should happen.
The shift is from disclosure to restoration
For me, this is a key factor when I look at the revised framework – it highlights that training should no longer be a tick-box module, but one that helps people practise the actual moments that matter: saying sorry without speculating, explaining uncertainty without sounding evasive, listening without becoming defensive, involving support people appropriately, and keeping the conversation going after the first meeting.
The expectation to tell patients when something has gone wrong is not new. What is becoming clearer is that the quality of the conversation matters. Good open disclosure is about timely, person-centred and compassionate communication: acknowledging what has happened, expressing apology or regret, listening to the patient’s experience, explaining what is known and what remains uncertain, outlining what happens next, and demonstrating how learning will occur.
That sounds straightforward. In practice, some of the most difficult communication work is in healthcare. These conversations often happen when patients are distressed, families are frightened or angry, clinicians are worried, facts are incomplete, and organisations are navigating competing pressures around compassion, accuracy, accountability, governance and legal risk. This is precisely why practical capability matters and training offered needs to help people rehearse the moments that matter.
Five questions every health service should be asking:
- Who is supported to have the conversation?
Open disclosure is often placed on the shoulders of the clinician closest to the event. That clinician may also be experiencing distress, guilt, uncertainty or fear about what has happened. Good systems don’t simply tell clinicians to disclose; they prepare, coach and support them to do it well. - Do our people know how to apologise well?
The words “I am sorry” or “we are sorry” remain central, but an effective apology is more than saying the words. Staff need to understand how to acknowledge what is known, express genuine regret, avoid speculation and blame, respond to emotion and communicate uncertainty honestly. - Can patients genuinely participate?
A conversation cannot be genuinely person-centred if the person cannot understand or participate in it. Plain language, interpreters, appropriate and easy-to-read material, assistive technology, advocacy support and cultural safety are not optional extras. They determine whether the conversation is meaningful. - Do we understand that disclosure is a process, not a meeting?
The initial conversation may occur before all facts are known. Follow-up, updates and continued support are often where trust is either rebuilt or further damaged. - Do we actually learn from what patients tell us?
Disclosure should connect to incident review, consumer feedback, safety improvement and staff support. Otherwise, the conversation risks becoming disconnected from system learning.
The training challenge is cultural, not just technical
Open disclosure training is often framed as a communication skills exercise. It is that, but it is also more than that. The conversation in the room reflects the culture outside the room. If staff believe that acknowledging harm will automatically lead to blame or punishment, they are less likely to communicate openly. If leaders respond defensively to complaints, staff will learn to protect the organisation rather than engage with the patient’s experience. If legal and governance advice is heard as “say as little as possible”, even well-intentioned clinicians may retreat into language that feels cold, carefully constructed or evasive.
This is where consulting with staff and training support can add real value. The opportunity to bring together policy, leadership expectations, scenario practice, consumer input and governance processes so that they reinforce rather than undermine each other.
A good open disclosure program should help organisations answer not only “what does the Framework require?” but “what do our people need to do this well?”
Implementation should focus on capability
In my view, the organisations that gain the most from the revised Framework will not be the ones that produce the longest procedure. They will be the ones that invest in practical capability at four levels.
- Individual capability: clinicians and managers need the confidence and skills to acknowledge harm, express regret, explain uncertainty, listen to impact and agree next steps.
- Team capability: teams need role clarity before, during and after disclosure. Who leads? Who supports the patient? Who supports the clinician? Who documents? Who follows up? Who communicates what the organisation has learned?
- Leadership capability: leaders need to model transparency, reinforce a just and learning-oriented culture and ensure staff are not left isolated after difficult events.
- System capability: incident review, complaints handling, consumer partnership, clinical governance and staff wellbeing need to connect, rather than operate as separate processes.
The real test is the patient’s experience
The real test is not whether a policy exists. It is whether a patient, family or carer feels safe, respected, informed and genuinely heard when something has gone wrong.
A final thought
The revised Australian Open Disclosure Framework gives health services a stronger foundation for honest, compassionate and person-centred communication when care does not go to plan. Still, the Framework will only matter if it changes what happens in real conversations.
When healthcare goes wrong, silence can become a second harm. Good open disclosure cannot undo what happened, but it can reduce avoidable distress, preserve dignity, support learning and begin the work of rebuilding trust. For me, that is the point: open disclosure is not just a compliance obligation. It is a leadership, culture and capability challenge.
Access the new framework here: Australian Open Disclosure Framework
Building capability for better open disclosure
Insync supports health services in translating the revised Open Disclosure Framework into practice through tailored training, practical scenarios, and capability building for leaders and teams.
