Organisational duty of candour: guidance

Annex D

Making an apology

For the purposes of the Act, an "apology" means a statement of sorrow or regret in respect of the unintended or unexpected incident that caused harm or death. The Act sets out that an apology or other step taken in accordance with the duty of candour procedure does not of itself amount to an admission of negligence or a breach of a statutory duty.

Sometimes clinical and care staff find it difficult to say sorry when something has gone wrong and harm has occurred. People may be unclear if they can say sorry and worry that the timing for doing this will not be right or that they will make things worse. The Four Rs are an easy way to remember how we can get this right:

Reflect – stop and think about the situation.

Regret – give a sincere and meaningful apology.

Reason – if you know, explain why something has happened or not happened and if you don't know, say that you will find out.

Remedy – what actions you are going to take to ensure that this won't happen again and that the organisation learns from the incident.

It is important that an open and honest apology is provided from the outset as this can reassure an individual and/or their family and will also set the tone for moving things forward from here.

By making an apology following an unintended or unexpected incident, you are acknowledging that harm has been caused, a mistake has been made and you may be acknowledging emotions that are felt by the individual and/or their family. A meaningful apology can help to calm a person who has become angry or upset. An apology is not an admission of liability.

What is a meaningful apology?

An apology is often the first step in putting things right and can help to repair a damaged relationship and restore dignity and trust. To make an apology meaningful you should:

• acknowledge what has gone wrong;
• clearly describe what has gone wrong to show you understand what has happened and the impact for the person affected;
• accept responsibility or the responsibility of your organisation for the harm done;
• explain why the harm happened;
• show that you are sincerely sorry;
• assure the individual and/or their family of the steps you or your organisation have taken, or will be taking to make sure the harm does not happen again (where possible);
• make amends and put things right where you can.

How should I make an apology?

Your apology should be based on the individual circumstances. There is no 'one size fits all' apology, but there are some general good practice points.

• the timing of the apology is very important and should be done without delay;
• to make the apology meaningful do not distance yourself from the apology or let there be any doubt that you or your organisation accept any wrongdoing;
• the language you use should be clear, plain and direct;
• your apology should sound natural and sincere;
• your apology should not question the extent of harm suffered by the person affected;
• your apology should not minimise the incident;
• it is very important that you apologise to the right person or people.

Who should apologise?

The Act states that the responsibility for the apology rests with the responsible person – this is the organisation delivering the service. Within each organisation there will be individuals with delegated responsibility for ensuring that the organisational duties (in this case providing an apology on behalf of the organisation) are met (recognising that there are likely to have been individuals who have provided individual apologies). Your organisation may have guidelines you can use.

For an apology to be effective it needs to be sincere. Sometimes you may need to apologise for an event which is not of your doing – indeed the organisationally focused apology required by the duty of candour procedure will involve this. Sometimes it is the official organisational recognition of the event that will be important to the individual and/or their family.

The timing of a more formal apology is at the discretion of the responsible person but best practice would be to also apologise immediately the event comes to light. When making your apology you should not worry about who is to blame or what has gone wrong but merely apologise for the event occurring.

It is the responsible person's responsibility to make an apology, where appropriate, and you could include some phrases such as:

'I am sorry that this has happened to you and I'm going to find out what went wrong and come back to you.'

'I am sorry that harm has occurred, let me find out what has happened and come back to you with information.'