Benefits and challenges of implementing statutory duty of candour in Victoria, Australia: a mixed methods analysis of healthcare provider perspectives.

Background: Statutory duty of candour (SDC) requires healthcare services by law to provide the patient or their family or carer who experiences a serious adverse patient safety event (SAPSE) with a written account of the facts, an apology, and the steps being taken to prevent reoccurrence. To date, the impact of SDC implementation has been understudied. As part of a state-wide evaluation of the impacts of SDC in the two years since its implementation in Victoria, Australia, this study focuses on staff and service delivery impacts of SDC. Methods: A mixed-methods design was employed, synthesising data from a 21-item survey with interview data. Health service staff working in Victorian health settings since SDC implementation in 2022 were recruited via state health agencies, professional organisations and social media. Survey data were subject to quantitative analysis using statistical software, with inductive content analysis applied to free text items. Reflexive thematic analysis was undertaken with the interview dataset. Results: A total of 170 respondents completed the survey, 25 of whom further participated in a follow-up interview. Survey participants were clinician managers (30%), nurses (24%), doctors (17%), allied health professionals (10%), and others (18%), primarily working in Victorian public (80%) and private (11%) hospitals. Staff reported greater awareness of SDC among staff with managerial responsibilities than frontline staff, with perceived gaps in staff knowledge about SDC and communication skills inhibiting practice. Seven themes further characterised the benefits, implementation challenges and implications of SDC: Promoting organisational accountability; Inconsistent event identification and review; Threshold for SDC is subject to interpretation; Prescriptive processes inhibit person-centred care; Context-specific implementation requirements; Adjusting to policy change; and Capacity and capability for implementation. Conclusion: Implementing SDC has contributed to greater structure, consistency and routine inclusion of patient and family perspectives when examining patient safety events. Opportunities for improvement identified by respondents and interviewees included developing person-centered and context-sensitive timeframes for communication, relaxing legalistic documentation requirements, findings ways to more consistently apply SAPSE definitions, and addressing the cultural implications and administrative burden of SDC requirements.