🩺💬 How to announce harm associated with care? Guidelines for informing, listening and preserving trust, useful for healthcare professionals and social-medical actors who support patients
🧭 The HAS guide details the three stages of the announcement, with concrete cases, technical sheets and a list of "Dos / Don'ts".
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1️⃣ SUMMARY
The guide starts from an observation: despite the law of 4 March 2002, the information provided to patients after an incident related to care " is not yet satisfactory," according to the results of the certification of establishments (p. 3). It is aimed at healthcare professionals working in healthcare establishments or in the community (p. 1, p. 7). The announcement is presented as a moral, etical duty and a legal obligation (art. L.1111-2 and L.1142-4 of the Public Health Code) (p. 7). The text outlines the reasons for its importance, the barriers (caregiver-patient relationship, error, fear of litigation) and the expected benefits (p. 8-11), then its link with risk management (p. 12). It then describes the preparation (p. 13-15), the implementation (p. 17-22) and the follow-up to the announcement (p. 23-24). Appendices provide testimonies, technical sheets, concrete cases, specific cases, legal points and the perspective of an insurer (p. 27-49).
2️⃣ WHAT TO REMEMBER
1️⃣ All physical or psychological harm is concerned. The guide indicates that all adverse events resulting in physical or psychological harm "must be the subject of an announcement," whether related to a complication, a therapeutic risk or an error. The severity is to be considered from the patient's perspective (p. 7).
2️⃣ An announcement in three stages, designed as a continuous process. Prepare, carry out, follow up (p. 13-24). Guidelines: as soon as possible, preferably within 24 hours, in compliance with the legal deadline of 15 days (p. 17, p. 19); regrets in all cases, apologies in case of proven error (p. 20); a reference person and follow-up appointments (p. 21, p. 23).
3️⃣ The involved professional also needs support. The guide mentions the concept of "second victim" to describe the suffering of the professional who made a mistake (p. 9). In establishments, a support unit "must be set up", with also a reiterated proposal for personalised support independent of the hospital institution for the caregivers directly involved; in the community, the professional must seek external support (p. 14). The annex dedicated to caregivers highlights that in 2011 the specific pathways addressing their needs, particularly for confidentiality and independence, remain very limited in France, especially for doctors (p. 35-36)
3️⃣ TO ACT
1️⃣ Formalise a disclosure policy in healthcare establishments (case 1: action requested by the document). It describes objectives, key steps and means, organises support for professionals and is subject to communication, notably via the patient welcome booklet (p. 13-14, p. 25).
2️⃣ Prepare a meeting with the tools from the guide (case 2: existing tools cited). Summary "To do / Not to do" (p. 25-26) and technical sheets on eethical questioning, active listening, predictable reactions of patients and support for professionals (p. 29-36). The guide recommends training, particularly through simulation (p. 13, p. 21).
3️⃣ Trace the announcement in the medical record (case 1: action requested by the document). Day, time and place; people present; facts presented; offers of support and reactions; questions and answers; follow-up plan; contact details of the referent (p. 21). Each follow-up appointment is also recorded (p. 23).
Suggestion Health Practices: for prevention actors, social workers or user representatives, annexes 5 and 6 (patient's entourage, avenues of recourse, p. 45-47) can serve as a basis to inform affected individuals. The cited institutional framework dates from 2011 and must be verified before any use (see section 7).
4️⃣ 3 PRACTICAL QUESTIONS
1️⃣ What is the timeframe for announcing the damage? The guide recommends scheduling the first interview as soon as the physical and psychological state of the patient allows, as soon as possible after the detection of the adverse event, preferably within 24 hours (p. 19). It reminds that, according to article L.1142-4 reproduced in the document, the information must be provided no later than fifteen days following the discovery of the damage or the express request of the person concerned (p. 7). In case of death, the guide recommends an immediate appointment with the rights holders (p. 19).
2️⃣ Apologising, does it mean acknowledging responsibility? The guide distinguishes between the presentation of apologies and the acknowledgment of medical-legal responsibility. When an error or a failure in care has been highlighted by the investigation of causes, it recommends presenting apologies in addition to regrets. It suggests the phrase "I apologise for what happened," rather than "I apologise, it’s my fault" (p. 20). The annex presenting the insurer's viewpoint also reminds that telling the truth about the facts does not equate to acknowledging responsibility and emphasizes the existence of contractual clauses on this matter (p. 49). This passage reflects the recommendations of the 2011 guide and does not constitute a legal guarantee applicable to every situation.
3️⃣ Can we inform the patient's relatives? According to the framework presented in this 2011 guide, confidentiality is the rule: involving relatives in the announcement generally requires the explicit consent of the patient. However, the guide specifies several particular situations: serious diagnosis or prognosis, patient unable to express their wishes, death, minority or guardianship. In the case of a serious diagnosis or prognosis, the information necessary to support the patient may be communicated to the family, relatives, or trusted person, unless the patient objects. The minor and the adult under guardianship receive appropriate information themselves. These provisions are detailed in the legal annexes of the guide and must be verified in the applicable texts before practical use (p. 7, p. 45-46).
5️⃣ TO GO FURTHER
Blog Health Practices: No verified supplementary resource has been identified. The research conducted did not reveal any article from the blog pratiquesensante.com on this topic; the site blocks automated consultation, a manual check remains necessary.
External resource: « Announcement of harm associated with care » — fact sheet from the national roadmap for patient and resident safety 2023-2025 (April 2025). It outlines the three stages of the announcement, cites a decision from the Council of State on 20 February 2025 regarding the communication of EIGS declarations and lists resources to support professionals. External source: publisher indicated « sante.gouv.fr »; attribution to the DGOS according to the name of the file, not verified. Hosting: France Assos Santé Hauts-de-France. Consulted on 30 October 2026.
Fact sheet « Announcement of harm associated with care » (April 2025, PDF)
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