Safe healthcare occurs in a sacred relationship between vulnerable patients, families, and health professionals. When something goes wrong, we usually respond with a detailed investigation that aims to examine what happened and learn for safety improvement. Whilst these goals are important, a growing body of evidence tells us that learning and improving must be balanced with healing.
A common theme of recent international inquiries is that well intentioned investigations often make things worse. Harm is compounded when we fail to listen, validate and respond to the rights and needs of all the people involved. When lengthy processes do not result in meaningful action, suffering can be exacerbated and result in further damage to wellbeing, relationships, and trust. At its worst, compounded harm produces undesirable outcomes such as a community believing an essential service is unsafe, or a clinician leaving their profession.
In considering how best to respond, it is important to remember that health systems are comprised of people and relationships, as well as rules and processes. Once we think about safety as a human and relational approach, rather than one that only seeks to lessen risk and enforce regulation, we can consider how to best proceed. Whether an act is intentional or not, a dignifying approach involves working together to repair the harm involved. Restorative responses are ideal for this purpose.
A restorative response is underpinned by the same relational values that are expressed in the NHS Constitution – informed choice, respect, dignity, compassion, truth, equity, and accountability. Restorative goals are congruent with everyday healthcare work because they aim to promote and repair wellbeing though dignifying relationships. Importantly, emerging evidence suggests that the approach can improve economic and workforce outcomes and mitigate the risk of compounded harm.
Regardless of the scale, there are some key components to a restorative response. Firstly, we identify the affected individuals and communities and explore their needs. By understanding how, to whom, and where people want to share their story, we can co-design a safe process. Providing desired supports can also mitigate trauma or distress. If it is safe for everyone involved, those responsible for repair and prevention are invited to listen and understand what happened and appreciate the lived experience involved.
By exploring what is possible together, a responsive and achievable pathway can be co-designed. For example, New Zealanders harmed by surgical mesh shared that learning and improving was important. However, they primarily wanted their injuries and suffering acknowledged and responded to as well as adequate compensation. A meaningful apology was described as the timely delivery of several actions that included the new National Pelvic Mesh Service.
So what next? We are currently collaborating to deliver the recommendations in our national framework Envisioning a Restorative Health System. There is much to learn about restorative responses so that we can ensure they are safe and supportive as we build capability and capacity. Our overarching goal is to ensure that all our people – both those providing and receiving care – feel seen and heard as though they matter.
Jo Wailling is Co-chair of the National Collaborative for Restorative Initiatives in Health Aotearoa New Zealand