A form of justice that heals the healing professions.
What is the Scope of RJ in Healthcare?
RJ in healthcare treats harm as more than just a biological phenomenon and it broadens the definition of healing to include prioritizing accountability for the social conditions that lead to healthcare inequities, the systemic issues that lead to medical errors, and the organizational dynamics that lead to interpersonal mistreatment.
RJ in healthcare spans medical education, clinical and non-clinical sciences, public health, policy, and financing––and it includes the perspectives of patients, family members, healthcare providers, learners, educators, and various non-clinical stakeholders. In essence, it is a values-based, holistic form of justice that empowers healthcare communities to prevent harm in the first place and to heal each other differently when harm does happen.
–– Pedro L. Flores, Ph.D.
RJ Philosophy
Must We Blame and Punish In Order to Attain Accountability for Harm?
RJ offers a fundamentally different approach to accountability than a punitive or blame-centric culture. In healthcare environments, for instance, our responses to harm typically fall into one of three patterns:
- Finding Someone to Blame: We often seek to identify an individual responsible for what is frequently a systemic issue.
- Using Punishment to Deter Harmful Behavior: Our focus often shifts to identifying which laws or policies were violated, rather than prioritizing the needs of those who have been harmed.
- Minimizing or Denying Impact: We may dismiss the effects of the harm through “selective accountability,” effectively gaslighting victims and sometimes retaliating against them further.
In contrast, RJ prioritizes the needs of those who have been harmed. It seeks to identify the individuals responsible for the harm and to explore how to repair it and rebuild trust through active accountability. This process is demanding and extends beyond mere surface-level apologies.
The restorative inquiry framework poses several critical questions:
- Who has been hurt, and what are their needs?
- Who is responsible for the harm, and what are their obligations?
- How can we rectify the situation (repair harm and rebuild trust)?
- How can we prevent this from occurring again?
RJ shifts the focus away from what laws or policies were violated (an offender-centric approach) and centers on the needs of the harmed parties (a victim-centric approach). This shift often results in higher satisfaction ratings from all parties after engaging in the restorative process.The success of restorative justice hinges on the involvement of key community members in a collaborative process of storytelling, accountability, and decision-making. This requires skilled facilitation and a community committed to healing and reconciliation.
RJ Origins & Global Impact
A Global Social Movement
Today's restorative justice practices have been inspired by numerous Indigenous peacemaking practices that have existed since time immemorial. For example, restorative circles, which are modeled after the Native American tradition of using a talking piece, create equitable dialogue and give every participant the opportunity to express themselves authentically and fully.
Restorative conferences, which are used to convene groups of people with a shared stake in a harm, offense or community concern, are modeled after the Māori family group conferencing model, which originated in New Zealand in the 1990s.
RJ has deep roots in Africa, where the social fabric of their people was soundly built on the truth, understanding the root causes of problems in the community, and reconciliation (Gabagambi, 2018). In fact, truth and reconciliation commissions (TRC), most notably the South African TRC of 1995, exemplify how public RJ forums can lead to communal healing by recognizing human rights violations and creating opportunities for truth-telling, reparations, amnesty, and reconciliation.
Iterations of modern-day restorative justice have been around for centuries, however, its contemporary application emerged in the 1970s in the criminal justice setting in Canada. To date, the RJ movement has successfully expanded into criminal justice, K-12 education, juvenile justice, and higher education settings, however, it is just beginning to be explored in healthcare and academic medicine.