A pervasive theme of healthcare reform globally is greater candour about the imperfections of care quality, particularly for patients and family members when things go wrong. Numerous healthcare systems now have published policies around disclosure. However, as Moore and Mello document in their paper in this issue of BMJ Quality and Safety,1 details about how, what and when to disclose are scant, and based on minimal evidence about what works for patients, families, clinicians and organisations. Moore and Mello provide important insights from New Zealand, where a mandatory system for compensation following treatment injuries has been in place for over 40 years, on how to achieve reconciliation that satisfies the concerns of aggrieved patients and carers while being acceptable to clinicians and organisations.

Moore and Mello relate their findings in particular to the North American context. The traditional medical malpractice liability system in the USA has long been criticised for its cumbersome, lengthy procedures, financial risks to all parties (healthcare organisations, patients and families, and lawyers), and tendency to prioritise minimisation of liability over learning and improvement.2 Communication-and-resolution programmes have been offered as an approach that might meet the expectations of patients and families more swiftly and sensitively, and encourage learning from mistakes rather than suppression and concealment.3 In England, too, there have been moves towards emulating systems in place in other countries to facilitate early resolution of compensation claims and encourage learning from incidents, with calls for the introduction of a …