New patient safety standards from JCAHO that require hospitals to disclose to patients all unexpected outcomes of care took effect 1 July 2001. In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place. More than half of respondents reported that they would always disclose a death or serious injury, but when presented with actual clinical scenarios, respondents were much less likely to disclose preventable harms than to disclose nonpreventable harms of comparable severity. Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure.T e ll i n g pat i e n ts a b o u t u nan t i c i pat e d o u tc o m e s of care is an established ethical expectation for physicians and nurses. 1 However, decisions about the appropriateness, timing, and content of disclosure have traditionally remained a private matter, left to the preferences of individual clinicians and health care institutions. Advances in informed-consent law and patients' rights over the past thirty years appear to have had little demonstrable impact on providers' willingness to disclose information about errors and adverse outcomes. 2 Today providers face new constraints in the area of disclosure. The Institute of Medicine's (IOM's) 1999 report, To Err Is Human, prompted calls for greater transparency in health care. 3 In July 2001 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) responded by introducing new patient safety standards, including a requirement that all unanticipated outcomes of care be disclosed. 4 Although the requirement itself does not specify the need to disclose poor

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