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While health practitioners typically endorse disclosure in principle, they often do not share information in practice, with studies suggesting that as few as 30% of harmful errors are disclosed to patients [8].

The most often cited barrier to open and honest communication following an incident is the fear of legal liability—that communication may lead to a lawsuit against them, a lack of legal protection when providing information and apologies and the potential loss of liability insurance if they say too much or the wrong thing [8, 9].

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The issue of open disclosure has received growing attention from policy-makers, legal experts and academic researchers, predominantly in a number of English-speaking countries.

While implementing open disclosure in practice is still an on-going process, open disclosure now forms an integral part of health policy in various American states, the UK, Canada, Australia and New Zealand, with a number of measures having been put in place to encourage open disclosure and to mitigate some of the barriers to such open communication.

While the open disclosure process can vary, it typically includes an acknowledgment; an expression of regret or an apology; an investigation into the incident; providing a factual explanation of what happened and explaining the steps being taken to manage the incident and prevent recurrence [1, 2].

The issue has received growing attention from policy-makers, legal experts and academic researchers, predominantly in a number of English-speaking countries.

While the importance of reporting incidents as part of quality improvement programmes has been recognized, lacking from the ongoing discussion has been the emphasis of the needs of patients in such situations.

Although there was a factorial survey of the general public regarding medical errors in 2004 [17], there is currently no empirical data relating to patients' or practitioners' attitudes and views regarding open disclosure, and very little is known about current practice.

Legal concerns, however, are not the only factor that may lead practitioners not to disclose incidents.

Indeed, such concerns can often disguise deeper emotional fears.

Before examining open disclosure in Germany, it is helpful to have an understanding of the wider context in which this discussion is situated.

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