Open disclosure is a valuable process which has the potential to benefit both the patients who receive the open disclosure and the health care professionals (or organisations) who provide it. The benefits from open disclosure will most often be seen when open disclosure is performed in an ‘ideal’ manner. When open disclosure is suboptimal, it can lead to harmful consequences for patients and health care providers alike. Numerous factors may contribute to an inadequate open disclosure including: potentially inadequate legal protection for health care professionals or organisations; failing to meet patient and/or family expectations; health care professionals experiencing a lack of education, training and support from the health care organisation; or a fear of litigation. An inadequate open disclosure may result in inadvertent consequences including: patients/families who are dissatisfied; potentially preventable litigation; legal repercussions for health care professionals and organisations; and patient harm where open disclosure is not implemented. This article seeks to explore these barriers and considers how the implementation of open disclosure could be improved to overcome these barriers. Overcoming these barriers should help to reduce the risk of inadvertent consequences and lead to better outcomes for patients, health care professionals and health care organisations.