Duty of Candour Guide

This resource, Duty of Candour Guide, is part of our growing library of practical patient safety material. It is placeholder content for design and will be replaced with real copy.

Clear, proportionate responses help organisations focus their limited time and energy where it will make the biggest difference to patients and families.

Common pitfalls to avoid

Engaging those affected early and honestly is not just good practice; it consistently leads to richer insight and more durable change.

Documentation should support learning, not replace it. The goal is a shared understanding that the whole team can act on.

What good looks like

• Agree owners and timescales for every action
• Check that changes have actually held a few months later
• Keep language plain, respectful and free of blame
• Focus on a small number of high-value improvements

A practical example

Small, well-supported changes that stick will always outperform ambitious changes that quietly fade once attention moves elsewhere.

1. Agree proportionate, owned actions
2. Review and share what was learned
3. Map what happened and who was involved
4. Explore the conditions and contributing factors

The goal is not to find someone to blame, but to understand the system well enough to make it safer.

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