National Framework Explores A Different Approach To Health Care Harm In Aotearoa New Zealand

A new national framework designed to support the health and disability sector to mitigate and respond to health care harm in Aotearoa New Zealand has been released today by the National Collaborative for Restorative Initiatives in Health (the Collaborative).

The framework, He maungarongo ki ngā iwi: Envisioning a restorative health system in Aotearoa New Zealand, was developed by the Collaborative in partnership with a diverse range of stakeholders over an 18-month period. It presents a human-centred and relational approach to mitigate the risk of compounded harm and maximise opportunities for healing, learning and improvement.

The Collaborative was established in 2020 to nurture and guide the development of restorative initiatives within the health and disability system. It is made up of representatives from national sector agencies, kaumātua and kuia, as well as consumers and clinicians who have lived experience of health care harm.

During its review of current practices when harm occurs in health care, the Collaborative heard perspectives from many involved in the process, from those harmed and their whānau to clinicians and investigators. The feedback was that many feel isolated and that the process is transactional, and linear, with a focus on assigning blame and privileging the expertise of clinicians over consumers.

Co-author of the framework and co-chairperson of the Collaborative Jo Wailling says, ‘Well-intentioned current approaches to harm often compound the harm that already has occurred rather than promote healing and the rebuilding of trust between the parties involved.’

The framework presents a restorative approach to responding to health care harm, which involves honest dialogue in a psychologically safe environment, guided by a concern to address harm, meet needs, restore trust, prevent repetition and promote repair.

An approach that honours Te Tiriti o Waitangi has been taken throughout the development of the framework. The concept of hohou te rongo (the kawa and tikanga that makes up peace-making from a Māori world view) sits equal to Western-developed restorative practice models. Hohou te rongo ensures the kawa and tikanga of iwi and hapū are upheld according to locality and setting.

Collaborative member Stephanie Turner, director of Māori health outcomes (Ahuahu Kaunuku) at Te Tāhū Hauora Health Quality & Safety Commission, says, ‘Hohou te rongo focuses on the importance of relationships, accountability and the restoration of balance when health care harm has occurred. It starts with understanding the needs of whānau and puts this at the centre of the approach to addressing harm.’

Restorative principles also underpin the revised Healing, learning, and improving from harm: National adverse events policy 2023 | Te whakaora, te ako me te whakapai ake i te kino: Te kaupapa here ā-motu mō ngā mahi tūkino 2023, which comes into effect 1 July 2023.

The framework includes recommendations to support the sector to embed restorative principles into all parts of the system intended to mitigate and respond to health care harm. The Collaborative will work with leaders and others across the health and disability system to implement the recommendations.

Read the framework and recommendations here.

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