Case study 2: Restoration and healing from harm
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
Restorative responses are relational in nature, meaning that human wellbeing and relationships are fundamental to the approach, and healing those relationships becomes a key objective in the aftermath of an incident alongside learning and improving. Humanistic values are central to the approach, including ideas around dignifying relationships, respecting confidentiality, and encouraging distributed leadership.
A restorative response to harm in healthcare may be defined as “a voluntary, relational process where ideally all those affected by an adverse event come together in a safe and supportive environment, with the help of skilled facilitators, to speak openly about what happened, to understand the human impacts, and the clarify responsibility for the actions required for healing and learning”. When it is not possible to bring people together, healing can still be achieved by responding to the needs expressed by the people who are directly impacted.
The National Collaborative for Restorative Approaches in Health in New Zealand, led by Jo Wailling and Graham Cameron, has pioneered restorative responses to harm. The team has co-developed a range of resources including a national framework that was co-designed with key stakeholders, and aims to embed restorative principles across policy, programme delivery and practice standards. They have also ensured that restorative approaches become part of a national approach in New Zealand and support a wider social movement in countries including Canada, the United States, the UK and Australia.
Why was it developed?
When a health care incident occurs, the default response of the system is to conduct an investigation to generate learning and prevent future harm. While vital, there is increasing recognition that the wide-ranging human impact of incidents on people’s wellbeing, relationships and trust, must not be ignored, or worse exacerbated, by the professional and organisational response to an incident:
“…we invented this term compounded harm because we felt we needed to find a way to get people in the system to prioritise it.”
The team in New Zealand was commissioned to deliver a restorative response intervention as part of the inquiry into harm caused by the use of surgical mesh. Evaluation of the work found that the process helped people to effectively communicate the experience of harm, feel validated, and preserve their dignity – attributes that can often by missing from traditional incident responses.
How can it be adopted?
There are some questions that can be asked as part of a restorative approach, facilitated by a skilled facilitator, who is invested in providing a safe and supportive process for everyone involved. The approach can be used whether attending to the needs of an individual or an entire community following harm. These questions include:
- Who has been or will be affected?
- What are the impacts and needs of all the people involved?
- Who is responsible for responding to those needs?
- What would it look like and feel like to be free of this harm in the future?
The team stresses that these questions should not be treated like a checklist, but instead form part of a range of approaches that should be co-designed with stakeholders and sensitive to the context in which they are being used:
“So we’re not saying here’s the recipe… [instead], It must be co-designed within the broader framework. I have confidence that people are going to develop restorative responses in a way that is connected, but also contextual … because if they just pick it up, and try and do the same thing, that won’t work”.
The new National Adverse Events Policy 2023 has recently been published, which incorporates restorative practice and responses as a core principle. An international network for restorative responses has also been set up to share learning and expertise, with contributions from around the world (please use the email address below to find out more).
How can the measurement of patient safety be improved?
In terms of restorative work, we need to know a lot more about the long term therapeutic, social, and economic impacts of how we current respond to harm and restorative responses. By identifying what works, for whom, and in what contexts and using this information to adapt system design will likely contribute to resilient systems that work better for all of the people who provide and receive healthcare.
“Often the data we collect… drives the design of the system, because you’re trying to focus on a specific outcome. Instead of starting from a point of trying to understand ‘what does safe care look like from to the people who are delivering it and receiving it?….”
“The goal should be to determine what works, for whom, and in what contexts… rather than believing that we can identify everything that matters, and by measuring and monitoring that we create safety.”
“Instead of an absolute focus on what the right metrics are, we should consider how we use what we're already collecting in a different way?”.
Key resources and contact details
Humanizing harm: Using a restorative approach to heal and learn from adverse events
Jo Wailling: jo@restorativeresponses.com
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