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Gillian Pearce. MHealSc 2010


Over the past decade there has been growing awareness that the delivery of health care can result in adverse events and that open disclosure can be an effective method to address the issues arising from incidents. In an attempt to further promote the concept of open disclosure, a series of changes have occurred within the New Zealand health system over the past few years. The aim of this study was to gain an understanding from a doctors' perspective of the open disclosure of adverse events following these recent changes. After reviewing the literature, there appears to be no recent qualitative studies on the perceptions of doctors on the concept of open disclosure following these changes, thereby highlighting the significance of this study.

Semi-structured in-depth face-to-face qualitative interviews were held with eight doctors working at Christchurch Hospital. The grounded theory methodology adopted directed the research process as themes and concepts grounded in the data emerged and the thematic analysis directed both the research subject and participant sampling decisions. The progression of the interviews refined the developing theory and once common perceptions were identified and the continuing interviews reached saturation point, the interview process was concluded. Three notable themes emerged from the data, organisational culture, external influences and professional autonomy. These themes aligned with the development of the study's research questions and were compared to the existing literature. The role of open disclosure as a component of creating a culture of quality and patient safety and the tensions surrounding its theory versus pragmatic underpinnings were examined in further detail. In addition, the approach to openly disclosing adverse events were also analysed and several recommendations were made to further enhance the concept of open disclosure. Overall this exploration of participants' views, attitudes, beliefs and experiences enabled a comprehensive theory of doctors' understanding of the open disclosure of adverse events to develop.

Supervisors:Gillian Abel, Pauline Barnett

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