Restorative justice after health care harm

Can principles of restorative justice help rebuild trust when things go wrong in healthcare? Could they be used in the NHS?

Fox_Kiyo Butterfly

In an article in HSJ written some years back, Dr Mike Roddis asked whether principles of restorative justice – most famously used in South Africa’s Truth and Reconciliation Commission following the end of the apartheid era – might usefully inform the approach to restoring trust after harm in healthcare.

Restorative justice has proven a useful alternative to formal criminal justice proceedings, bringing offenders and their victims together in a way that has a profoundly beneficial effect on both. Similar principles, referred to as restorative practice, are also used in schools to restore harmony after conflict. When we look at how the Restorative Justice Council summarises the key principles, their applicability to restoring trust after harm in healthcare is readily apparent:

  • the primary aim is to repair harm;
  • there should be agreement about the essential facts of the incident and an acceptance of involvement by the person who caused the harm;
  • participation is voluntary;
  • the process requires acknowledgement of the harm or loss experienced, respect for the feelings of participants and an opportunity to consider, and if possible, meet their needs;
  • where amends are made the person harmed should be the primary beneficiary and this reparation should be acknowledged and valued; and
  • the person facilitating the process must act impartially

These principles are mirrored in the ethical practices for restoring trust that I developed in collaboration with Murray Anderson Wallace. The seven practices we identified as markers of quality evolved out of my research into moral leadership, and from Murray’s testimony from patients and their families who had experienced (sometimes catastrophic) harm.

Researchers and practitioners in New Zealand have taken their thinking and work much further, and have introduced restorative practices into their activities with patients who have been harmed. This powerful film shows what these are, how they work and the impact they can have. It might be worth noting that one key difference between the UK and NZ is that NZ introduced a ‘no fault’ compensation system many years ago. This may make it easier to move away from the legalistic approaches that can dominate responses to harm in the UK, but this is something we can only find out if we are creative enough to try it.

Here in the UK, the Harmed Patients Alliance is campaigning for a more caring and restorative approach in the aftermath of harm, and is working with Action against Medical Accidents to develop a harmed patient pathway with interested NHS organisations.

Do get in touch if you’d like to talk about restorative practices and how you might be able to take this forward in your organisation.

Image: Butterfly by Fox_Kiyo via flickr CC: by 2,0