© 2008 The Authors. Journal compilation © 2008 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd. Published by Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA Sociology of Health & Illness Vol. 31 No.2 2009 ISSN 0141–9889, pp. 262–277 doi: 10.1111/j.1467-9566.2008.01131.x Blackwell Publishing Ltd Oxford, UK SHIL Sociology of Health & Illness 0141-9889 1467-9566 © 2008 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd XXX Original Article Practising Open Disclosure Rick Iedema, Christine Jorm, John Wakefield et al. Practising Open Disclosure: clinical incident communication and systems improvement Rick Iedema 1 , Christine Jorm 2 , John Wakefield 3 , Cherie Ryan 3 and Stewart Dunn 4 1 Arts and Social Sciences, University of Technology, Sydney, Australia 2 Australian Commission on Safety and Quality in Health Care 3 Patient Safety Centre, Queensland Health, Australia 4 Discipline of Psychological Medicine, University of Sydney, Australia Abstract This article explores the way that professionals are being inducted into articulating apologies to consumers of their services, in this case clinicians apologising to patients. The article focuses on the policy of Open Disclosure that is being adopted by health care organisations in the US, Canada, the UK and Australia and other nations. Open Disclosure policy mandates ‘open discussion of clinical incidents’ with patient victims. In Australia, Open Disclosure policy implementation is currently being complemented by intensive staff training, involving simulation of apology scenarios with actor-patients. The article presents an analysis of data collected from such training sessions. The analysis shows how simulated apologising engages frontline staff in evaluating the efficacy of their disclosures, and how staff may thereby be inducted into reconciling their affective and reflexive sensibilities with their organisational and professional responsibilities, and thereby produce the required organisational apology. The article concludes that Open Disclosure, besides potentially relaxing tensions between clinicians and consumers, may also affect how staff experience and enact their role in the overall system of health care organisation. Keywords: Open Disclosure, apology, simulation training, incident communication Introduction The past two decades have seen governmental and political institutions increasingly colonise the discourse of the interpersonal apology. As exemplified in a recent story about Fijians apologising for cannibalising a missionary in 1838 (‘Fiji villagers say sorry for eating British missionary’, Telegraph U.K., 12 Sep 2007), the apology has become common socio-cultural currency for negotiating, repairing and strengthening relationships between nations, between politicians and the public, and between governments and citizens. Indeed, this recent colonisation of ‘sorry’ as a means to public reparation has been described as ‘a wave of apologies’ which is ‘an integral part of the democratisation process that accompanied the end of the Cold War’ (Borneman 2005: 53). Examples often cited in this regard include Tony Blair’s apology for the Irish potato famine (1997) and Bill Clinton’s apology for the