Dr. Philip Crowley:

That is a very difficult question to answer with exactitude, but I will answer it. There will always be instances where individuals under stress, feeling ashamed of what has happened, feeling stress or whatever, fail to do what we would want them to do which is to openly disclose. What we do is put policy out there. We train people on it. We try to de-stress it. We try to ensure management supports people in something because one has to support staff when things go wrong as well; otherwise they will not necessarily do the right thing. I do not think one can ever guarantee that in every instance of an adverse event. I cannot say, hand on heart and with absolute certitude, that in every instance open disclosure will happen. What we want to do is make sure it does.

We do not just do the training and see what happens. One of the things we have done is that we did an audit of four hospitals and looked at charts in those hospitals. In those charts we found 33 events that should be disclosed and in those hospitals disclosure happened. I think it is starting to happen and if we continue training the trainers and maintaining the lead roles around the hospital groups and the community healthcare organisations, I think one will see the culture continue to change.