Why Candour Matters

Candour is open, honest communication when care, services, or systems fall short.^[1][6] It protects patients, sustains trust, and enables learning by making clear how risks will be reduced next time.^[4][6]

Principles, safety, and public confidence

GOC Standard 19 sets the expectation that candour is used when things go wrong.^[1] In practice, openness functions as a clinical safety behaviour that helps prevent secondary harm, preserves therapeutic relationships, and reduces escalation to complaints or litigation.^[4][6] Patients often judge integrity by timeliness, clarity, and the match between words and actions.^[3]

Early acknowledgement and investigation

Candour usually begins early.^[4][6] Concerns are acknowledged promptly-even when facts are incomplete-alongside a brief explanation of how the issue will be examined. Defensive language and speculation tend to be avoided; teams focus on what is currently known and what will be checked.^[3] Agreeing when and how updates will arrive helps prevent silence being read as avoidance.^[3][4]

• High-yield behaviours: apologising without delay; explaining what happened in plain language; outlining immediate safety measures; agreeing next steps with dates and names.^[1]
• System supports: a concise candour checklist; a private space for conversations; templates that record who said what, when, and why.^[4]

Showing impact and offering support

Openness often includes an account of impact.^[6][1] Patients benefit from clear clinical implications, practical supports (for example, replacement spectacles or expedited referral), and a named contact for queries. Written summaries in accessible formats help retain detail during stressful moments.^[1][6]

Psychological safety for teams

Candour is easier where psychological safety is present.

^[5]

Leaders who model immediacy, avoid blame language, and emphasise system fixes help create that environment.^[5] Locums and new starters benefit from the same training and access to incident systems so standards hold on busy days.^[1]

Recording accountability and near misses

Proportionate records support accountability. Notes typically include facts, any apology offered, patient preferences, and agreed actions with review dates.^[2][1] Incident analysis is kept separate from patient notes and cross-referenced so the story remains coherent. Where significant harm may exist, early contact with indemnity providers is prudent.^[1]

Candour frequently extends to near misses when a patient was exposed to risk or distress, even if harm was avoided. A brief call or note can prevent rumours, support trust, and surface improvements that avert future incidents.^[4][2] Patients often recall tone and follow-through more than exact phrasing, so language that is calm, specific, and humane tends to land best.^[6]

References (numbered in text) Why we include references

1. The professional duty of candour — General Optical Council Find (opens in a new tab)
2. Regulation 20: Duty of candour — Care Quality Commission (2024) Find (opens in a new tab)
3. Saying sorry when things go wrong — NHS Resolution Find (opens in a new tab)
4. Being open about unanticipated problems in health care: the challenges of uncertainties — Yvonne Birks; Vikki Entwistle; Reema Harrison; Kate Bosanquet; Ian Watt; Rick Iedema — Journal of Health Services Research & Policy (2015) Find (opens in a new tab)
5. Psychological Safety and Learning Behavior in Work Teams — Amy Edmondson — Administrative Science Quarterly (1999) Find (opens in a new tab)
6. Open disclosure — S Philpot; A Sherwin; S Allen et al. — BJA Education / British Journal of Anaesthesia Education (2024) Find (opens in a new tab)