Factors Influencing Statutory Duty of Candor Implementation in Victoria, Australia

Abstract

BACKGROUND: Globally, candor-type legislations, which encourage transparency following a serious adverse patient safety event (SAPSE), exist in various countries, or jurisdictions within them, including the United Kingdom, Canada, Germany, Ireland, and Australia. However, an evidence gap exists in the barriers and facilitators to the legislation's implementation. This study explores key influencers on Statutory Duty of Candor (SDC) implementation in the Australian state of Victoria from the perspectives of health care managers, patients, and families. METHODS: A thematic secondary analysis of 20 interview transcripts: 10 with health care managers experienced in SDC; and 10 with patients and family members who had experienced a SAPSE. Indicative themes were established inductively, and then overlaid and analyzed deductively to evaluate relevance using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Participants reported that SDC improved visibility and accountability regarding patient safety and incident management. However, findings also indicated misalignment, between the legislation's intent and its interpretation, and between health services' objective to meet the legislated requirements and patients' and families' objective to access support for recovery. The study also identified barriers, including clinician apprehension about SDC's impact (eg, blame and/or scrutiny) and concerns about the practicalities of legislated requirements (eg, flexibility of timelines and consistent interpretation of definitions). CONCLUSION: The findings indicate support for the intent and principles of SDC, but also highlight barriers which constrain the legislation's implementation and effectiveness in practice. These barriers may be addressed by extending SDC's focus to encompass restorative approaches (eg, by offering individualized support), while also assisting health system learning and quality improvement.