Using restorative practice in health care

The NHS's A Just Culture Guide encourages colleagues to treat staff involved in patient safety incidents with fairness, in a systematic way (NHS England/NHS Improvement, 2021). The guide supports conversations regarding whether staff involved in a patient safety incident require specific individual support or interventions to work safely.

The Williams review (2018), into Gross Negligence Manslaughter in Healthcare stated:

‘A just culture considers wider systemic issues where things go wrong, enabling professionals and those operating the system to learn without fear of retribution … Generally in a just culture, inadvertent human error, freely admitted, is not normally subject to sanction to encourage reporting of safety issues.’

In a just culture, investigators aim to understand why failings occurred and how the system led to sub-optimal behaviours. A just culture does, however, hold people appropriately to account where there is evidence of gross negligence or deliberate acts.

In my experience, clinical teams meeting with families in response to complaints is common practice and can be mutually beneficial when handled well. I frequently interact with patients and families as part of a complaints or patient safety investigation, and often staff involved in serious patient safety incidents ask to meet with those affected. Equally, patients and families often ask to meet staff involved. Although, in my experience, duty of candour is well executed, as investigations progress, the process is led by senior trust staff. On reflection, this may be driven by a desire to protect staff from a feeling of blame as the emotional impact for staff involved in serious incidents has a significant personal and professional impact. Staff are often referred to as ‘second victims’.