Patients harmed by care are owed honesty. The practice adopts a process based on the national Open Disclosure Framework published by the Commission: as soon as practicable after an adverse event the responsible clinician, with support, tells the patient and where appropriate their family what happened, expresses regret with an apology, explains what is known about why it occurred and what the consequences may be, describes what will be done to care for the patient and to prevent recurrence, and documents the discussion. The team is trained in the process and knows to involve the indemnity insurer early.
The graph holds this control, the 0 it maps to, and the evidence behind each claim, over MCP and REST.