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, PhD, MAS, RRT, CCRP
RJ Philosophy
Must We Shame and Punish In Order to Attain Accountability for Harm?
What I mean by RJ in healthcare is a form of justice that is fundamentally different than that of a blame culture. When something goes wrong in healthcare environments, we tend to respond in one of three punitive ways: (1) we find someone to blame for what is often a systemic problem, (2) we attempt to deter harmful behavior by focusing on a law or policy violation rather than prioritizing the needs of harmed parties, or (3) we minimize or deny the impact of harm altogether––essentially gaslighting those who've been harmed and oftentimes using retaliation to punish them further.
Conversely, RJ focuses on meeting the needs of harmed parties, identifying those responsible for the harm, and exploring what it would take to repair the harm and rebuild trust through active accountability, which is hard work and goes far beyond surface-level apologies.
Thus, the restorative framework seeks to answer the following questions:
- Who has been hurt and what are their needs?
- Who is responsible for the harm and what are their obligations?
- How can things be put right again?
- How can we prevent this from happening again?
Fundamental to the success of RJ is involving key community members in a collaborative process of storytelling, accountability and decision-making, which requires skilled facilitation and a community that is both willing and able to chart a path toward healing.
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.