Restorative initiatives: Emerging insights from design, implementation and collaboration in five countries

Jo Wailling ^1,2* Graham Cameron ^1,3 Iwona Stolarek ⁴ Turner Stephanie ⁵ Beelah Bleakley ⁶ Nick O’Connor ⁷ Catriona Harwood ⁸ Michael Power ⁹ Kathryn Turner ⁸ Allison Kooijman ^10,11 Nelly Oelke ¹⁰ David Gustafson ^12,13 Rob Robson ¹⁴ Murray Anderson Wallace ¹⁵ Gerard Drennan ¹⁶ Jo Hughes ^17,18 Jane K O'Hara ¹⁹ Fin Swanepoel ¹⁶ Christopher H LeMaster ²⁰

• ¹ The National Collaborative for Restorative Initiatives in Health, Wellington, New Zealand
• ² Faculty of Health, Victoria University of Wellington, Wellington, Auckland, New Zealand
• ³ Ngāti Ranginui, Waitaha ā Hei, Ngāti Rangiwēwehi, Ngāti Hinerangi, Tauranga, New Zealand
• ⁴ Royal Australasian College of Medical Administrators, Wellington, New Zealand
• ⁵ Ngāti Raukawa Ki Te Tonga, Ngāti Toa Rangatira, Te Arawa, Manawatū/Horowhenua/Kāpiti, New Zealand
• ⁶ ACT Health Directorate, Canberra, Australia
• ⁷ Clinical Excellence Commision NSW, Sydney, Australia
• ⁸ Metro North Hospital and Health Service, Herston, Queensland, Australia
• ⁹ Queensland Health Victim Support Service, Queensland, Australia
• ¹⁰ School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
• ¹¹ Restorative Research and Innovation Lab, Dalhousie University, Hallifax, Canada
• ¹² Community Justice Initiatives Association, Langly, Canada
• ¹³ Centre for Restorative Justice, Faculty of Arts & Social Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
• ¹⁴ Principal Advisor Healthcare System Safety & Accountability, Winnipeg, Canada
• ¹⁵ Health Systems Innovation Unit, London South Bank University,, London, United Kingdom
• ¹⁶ South London and Maudsley NHS Foundation Trust, London, United Kingdom
• ¹⁷ Harmed Patients Alliance, Caimbridge, United Kingdom
• ¹⁸ Restorative Justice Council, London, United Kingdom
• ¹⁹ THIS Institute, University of Cambridge, Cambridge, England, United Kingdom
• ²⁰ Kaiser Permanente, Oakland, California, United States

Restorative systems are human centred and distinguished by an emphasis on relational principles and practices. Emerging evidence indicates that a restorative approach holds promise to mitigate and respond to harm in the complex health environment. Advocates are collaborating with clinicians and institutions to develop restorative responses to adverse events. This paper shares the insights of an international network who have been collaborating to nurture the development of restorative policy and practice in five countries since 2019 (Aotearoa New Zealand, Australia [New South Wales & Queensland]; Canada [British Columbia], England and the United States [California]). Our work is at varying stages of maturity and incorporates co-designing, implementing, and evaluating a restorative approach to adverse events. The viewpoint provides an overview of the core principles, emerging evidence, and shares our collective reflections about the constraining and enabling factors to development. We recognise that we cannot speak to the breadth of work underway worldwide. Our hope is that by drawing on our experiences, we can offer some thoughts about what a restorative lens offers the future of patient and family involvement in patient safety, whilst providing the opportunity for transparent critique of work to date.