Clinical placement learning experiences are integral to all health and medical curricula as a means of integrating theory into practice and preparing graduates to deliver safe, high quality care to health consumers. A growing challenge for education providers is to access sufficient clinical placements with experienced supervisors who are skilled at maximising learning opportunities for students. This paper reports on the development and evaluation of an innovative online learning program aimed at enhancing student and clinical supervisors' preparedness for effective workplace-based learning. The evidence-based learning program used 'story-telling' as the learning framework. The stories, which were supported by a range of resources, aimed to engage the learners in understanding student and supervisor responsibilities, as well as the expectations and competencies needed to support effective learning in the clinical environment. Evaluation of this program by the learners and stakeholders clearly indicated that they felt authentically 'connected' with the characters in the stories and developed insights that suggested effective learning had occurred.

This report presents our Evaluation of Program 1 Stage 2 of the NSW Health Emergency Department Co-design Project. This Evaluation was conducted approximately 24 months after the initiation of Stage 1 of the Co-design and complements the Stage 1 Evaluation report published in December 2008. Data for this Evaluation were derived from the following five sources: Co-design documentation provided by the 4 sites, interviews with 41 key informants, a site observation and tour, legislative, policy and academic literature, and performance data about Emergency Departments, including the 2009 NSW Health site specific, Area and State level Patient Survey Reports. The Evaluation of Program 1 Stage 2 reveals that Co-design in the three NSW sites sustained and extended the improvements, changes in practice, and learnings for clinical and health departmental staff achieved during Program 1 Stage 1.

In contrast to as little as a decade ago, open disclosure is now regularly the subject of government policies, professional conferences and academic publications Open disclosure has been advocated since the late 1980s for a variety of reasons, including organisational and legal risk management considerations and, more recently, the need to show respect for the feelings and dignity of victims of adverse events. This article examines the insurance and other legal implications of open disclosure in Australia.

In this introductory chapter, we talk about why communication is so important in health care. Indeed, we believe that communication is central to safe and good quality health care. We know that for many people communication is something we do naturally. It is taken as given, and not considered worthy of very much attention. People may also think there are more urgent things to worry about, such as technical precision, clinical knowledge and professional skills. Communication has been defined in different ways. A recent NHS document defines communication in these terms: Communication is a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings or other information through both verbal and non-verbal means, including face-to-face exchanges and the written word. (National Health Service, 2010) The above definition of communication suggests that communication takes place face-to-face, non-verbally and in writing. We know, however, that communication also increasingly relies on information and communication technologies (ICTs). ICTs harness all kinds of visual and numerical information, as well as language.

We are grateful for Megan-Jane Johnstone making a broader readership aware of the open disclosure process. Whilst hindsight is a wonderful thing, we nevertheless take this opportunity to respond to a number of her propositions, if only to bridge the gap between conjecture and what is now rapidly becoming reality. Prior to the introduction when describing what open disclosure is, Johnstone does alert the reader quite rightly to the fact that the open disclosure standard has been piloted nationally. At the time of her writing, a final report on the outcomes of the pilot project was submitted to the Australian Commission on Safety and Quality in Health Care. It is worthwhile to signal the publication of this report, to prepare the reader for the opportunity to temper opinion with fact (see Ref. 1; Final report A National Evaluation of the Open Disclosure Pilot at http://www.health.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-02_PilotNODstd). As that report clarifies (also see Ref. 2), the primary method of data collection was the interview. The total number of interviews conducted was 154. Of these, 131 were conducted with health professionals (24 NSW, 29 SA, 33 VIC, and 68 QLD) and 15 were conducted with patients and 8 with (unrelated to these patients except one) family members. All interview sessions were audio-taped and transcribed, resulting in just under 2000 pages of data. Within the limits of the patient group sample size, we believe that this is in fact the robust empirical research Johnstone demands. More importantly, the report demonstrates the benefits of open disclosure to those concerned.

This chapter considers the role of the law in communicating patient safety. Downie and colleagues' (2006) 'preventing, knowing and responding' theoretical framework is adopted to classify the different elements of patient safety law. Rather than setting out all relevant patient safety laws in detail, this chapter highlights key legal strategies which are employed to prevent the occurrence of a patient safety incident ('preventing'); support the discovery and open discussion of patient safety incidents when they do occur ('knowing'); and guide responses after they occur ('responding') (Downie et al., 2006). After highlighting some legal strategies used to communicate patient safety, two practice examples are presented. The practice examples highlight different aspects of patient safety law and are indicative of communication issues commonly faced m practice. The first practice example focuses on the role of the coroner in communicating patient safety. It highlights the investigative role of the law in relation to patient safety (knowing).

The 'Health Practitioner Regulation National Law Act 2009' (Part 8, Sections 140 and 141) enshrines mandatory notification in the new national registration framework. As registered health practitioners, clinician-researchers are bound by the notification requirements. This raises the question of whether mandatory notification has implications for observational research in health services that is conducted by clinician-researchers. In particular, how likely is it that these requirements will lead to reclassification of one's observations from "research data" to "notification evidence"?

Australian Lawyers Alliance Having now interviewed close to 150 patients and relatives involved in hospital-caused harm, we know that the principal gestures that patients expect are: an apology; timely and honest communication and information flow; acknowledgement of the error and for responsibility to be taken; reassurance that the incident will not happen again and that the service seeks to improve as a result of the incident; and emotional support. One other important expectation is financial support. Where reparative gestures are predominantly communicative in nature, financial support has, besides a communicative dimension (as gesture), also a material dimension (as resources, for example, money). Deciding what is appropriate financial compensation is challenging for a number of reasons. Australian health services, by and large, tend to shy away from offering compensation outside of a finding of legal liability. This may be because the service's insurer refuses to repay the service for monies paid in this way. It may also be because the service lacks the necessary bureaucratic-administrative mechanisms for making money available to patients who are harmed , or for determining amounts to pay for non-hospital related costs. Or it may be that the service's lawyer advises against awarding payments lest they be converted into attributions of legal liability under our fault-based system of compensation. In some states - for example, Queensland - public system monies have now been made available by the health bureaucracy to allow services to make limited 'ex gratia' payments. Findings from our Open Disclosure studies indicate that both clinicians and patients want a better method of providing compensation, including 'ex gratia' payments, for expenses incurred as a result of adverse incidents.

Objective: To assess the attitudes of health care professionals engaged in open disclosure (OD) to the legal risks and protections that surround this activity. Design and participants: National cross-sectional survey of 51 experienced OD practitioners conducted in mid 2009. Main outcome measures: Perceived barriers to OD; awareness of and attitudes towards medicolegal protections; recommendations for reform. Results: The vast majority of participants rated fears about the medicolegal risks (45/51) and inadequate education and training in OD skills (43/51) as major or moderate barriers to OD. A majority (30/51) of participants viewed qualified privilege laws as having limited or no effect on health professionals' willingness to conduct OD, whereas opinion was divided about the effect of apology laws (state laws protecting expressions of regret from subsequent use in legal proceedings). In four states and territories (Western Australia, South Australia, Tasmania and the Northern Territory), a majority of participants were unaware that their own jurisdiction had apology laws that applied to OD. The most frequent recommendations for legal reform to improve OD were strengthening existing protections (23), improving education and awareness of applicable laws (11), fundamental reform of the medical negligence system (8), and better alignment of the activities of certain legal actors (eg, coroners) with OD practice (6). Conclusions: Concerns about both the medicolegal implications of OD and the skills needed to conduct it effectively are prevalent among health professionals at the leading edge of the OD movement in Australia. The ability of current laws to protect against use of this information in legal proceedings is perceived as inadequate.

Objective: To determine which aspects of open disclosure "work" for patients and health care staff, based on an evaluation of the National Open Disclosure Pilot. Design, setting and participants: Qualitative analysis of semi-structured and open-ended interviews conducted between March and October 2007 with 131 clinical staff and 23 patients and family members who had participated in one or more open disclosure meetings. 21 of 40 pilot hospital sites, in New South Wales, South Australia, Victoria and Queensland, were included in the evaluation. Participating health care staff comprised 49 doctors, 20 nurses, and 62 managerial and support staff. In-depth qualitative data analysis involved mapping of discursive themes and subthemes across the interview transcripts. Results: Interviewees broadly supported open disclosure; they expressed uncertainty about its deployment and consequences, and made detailed suggestions of ways to optimise the experience, including careful pre-planning, participation by senior medical staff, and attentiveness to consumers' experience of the adverse event. Conclusion: Despite some uncertainties, the national evaluation indicates strong support for open disclosure from both health care staff and consumers, as well as a need to resource this new practice.