Abstract
Background: Healthcare harm continues to occur in our health and social care systems. In Canada, adverse events in healthcare occur every minute and eighteen seconds, resulting in 28,000 deaths per year. Not only does healthcare harm include traditional adverse events, but it includes racism, discrimination, lateral violence amongst healthcare providers, and a culture that lacks relational practices. Our current health human resource challenges contribute to patient safety, relationships between providers, and health system culture. Harm can impact patients, providers, or organizations and can include physical harm, psychosocial, discrimination, compounded harm, communication, and institutional/system factors. A restorative approach is a relational approach, based on a set of key principles that has the potential to address healthcare harm and wellbeing. The use of a restorative approach moves away from a more traditional approach to healthcare harm (transactional, punitive and risk-aversion) to repairing relational harm, supporting just relations and building or re-building trust. Furthermore, it supports learning for current and future harms. Restorative justice approaches have been used in Canada and internationally in the justice system and education for many years. In healthcare, adapted versions of restorative justice with a more appropriate title, restorative approach, is a relatively new approach and has been successfully used in New Zealand (surgical mesh harm), Australia (Canberra Restorative Community) and the UK (Restorative Just and Learning Culture) in various formats. In British Columbia (BC), Canada, the concept of a restorative approach has been socialized through a leadership symposium, several training options including the development of a course in Foundations of a Restorative Approach, and a feasibility study is currently underway.
Approach: Objectives include: 1) to define key concepts of a restorative approach; 2) how a restorative approach could be used in healthcare; and 3) key initiatives in BC.
Results: Key components of a restorative approach will be shared and international examples will be provided. BC has undertaken various activities (training events, leadership symposium, and Foundations of a Restorative Approach course) to socialize and move towards the use of a restorative approach in healthcare. Finally, we will share key components of our protocol for our feasibility study (using a restorative approach in the health system) to be undertaken in one of our health authorities in BC.
Implications: A restorative approach has the potential to improve outcomes for patients, community members, healthcare providers and healthcare organizations. Building and (re)building trust through health system transformation is a key to facilitating integrated care.