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UBC Theses and Dissertations

Healing after healthcare harm : the potential of a restorative approach Kooijman, Allison Leigh


Abstract Background: Patient safety is a priority in health systems across Canada and globally. Despite a sharp focus on patient safety, medically adverse events continue to occur; approximately one in ten patients will experience a medical error at any given acute care hospital visit. Given the frequency of the occurrence of harm that is a product of the healthcare system, it is imperative that health systems can respond to patient harm in a way that does not compound the harm to either the harmed patient, their families, or the involved healthcare practitioners who also experience harm in these unfortunate circumstances. Research Design: This research proposal seeks to understand how and where a restorative approach, based on the principles of restorative justice, is being used to address healthcare harm along with its efficacy in doing so, as an emerging approach. This thesis employed a restorative approach framework to identify relevant initiatives through a scoping review and subsequent environmental scan to locate relevant documents. Expert interviews were conducted to further explore a restorative approach in healthcare and fill in the gaps. Interviews were conducted using a semi-structured interview guide. Findings: The scoping review of the academic literature did not result in any studies that fit all the inclusion criteria. Twenty-three articles were screened at the full text level and did serve to identify two key themes which were of relevance to this research: (1) extant frameworks for medical liability are problematic and, (2) Communication and Resolution Programs (CRPs) are increasingly being employed in the United States to respond to patient harm. The environmental scan did point to a few initiatives of note, but mostly this area of study is nascent and emerging. Descriptive and thematic analysis of the interview data revealed four themes related to using a restorative approach in healthcare: barriers, facilitators, culture change, and responsibility taking. Discussion: Using a restorative approach to respond to healthcare harm is beginning to emerge in the healthcare context in various areas with the potential to shift culture, strengthen community and relationships between the healthcare system and its stakeholders, and respond to harms in a manner that seeks to avoid compounding existing harm.

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