14 Sep 2021 | Adverse Events
A new film, Pou hihiri, Pou o te aroha | Healing and learning from harm, features consumers, clinicians and researchers talking about the benefits of following a restorative approach after a harmful event occurs in health care. Restorative practice and hohou te rongopai (peace-making from a te ao Māori world view) are described – both provide a response that recognises people are hurt and their relationships affected.
A restorative approach is where those affected by a harmful event come together in a safe and supportive environment to talk openly about what happened and the impact it has had on their lives, and to clarify the responsibility for the actions, for healing and learning.
The focus is on participation, respectful listening and communication, truthfulness, accountability, empowerment and equal concern.
Jo Wailling, research fellow at the Centre of Restorative Justice, Te Herenga Waka, Victoria University of Wellington, says current investigative approaches to harm are well intentioned but are characterised by letter-writing and written documents, and generally there's somebody who decides if a harmful event has occurred.
‘In the aftermath of harm and through the processes that follow – disclosure, investigation, resolution and change – the experience of harm can be compounded,’ she says.
Graham Bidois Cameron, Pou Tikanga at Bay of Plenty District Health Board, says the current approach does not work for Māori.
‘We need to understand that our system is perceived as a threat to whānau Māori, so when Māori are coming into the system, they're not starting in a place of trust. The system works when people believe it's going to work for them; Māori don’t believe this.
‘Māori respond to a relational approach, rather than the risk approach we see currently. A hohou te rongopai approach is about the restoration of mana and wellbeing, through whanaungatanga. It connects people and provides a pathway for resolving complaints and adverse events, consistent with a Māori understanding of wellbeing.’
Charlotte Korte from Mesh Down Under – a consumer advocacy group that supports New Zealanders harmed by surgical mesh – says the restorative approach to surgical mesh harm led by the Ministry of Health lets everyone share their views.
‘The difference between reading a report and sitting down with a patient, their family or whānau and hearing their story is huge. The surgical mesh issue unearthed a whole lot of trauma and damage. We had been raising concerns for years and banging our heads against a brick wall, and it felt like nobody was listening.
‘Even though I was sceptical about the restorative process to start with, I think it was the right move because you can't keep doing the same thing and expecting something to change. There needs to be a clear indication of what action is going to be taken, whether it’s going to be evaluated, and that it's meaningful and prevents further harm,’ she says.
Dr Andrew Simpson, former chief medical officer at the Ministry of Health, says a restorative approach provides a format where clinicians really listen and understand each person’s story of harm.
‘This is a mechanism for people to express their feelings and the impact of the harm that has happened to them. It's not personally directed.
‘You can’t put your own take on the event until you've heard everything, and that can take you in a different direction than if you'd reacted to only part of the story. Something in the system may not be working; how do we turn that around, how do we learn from what happened to ensure it doesn't happen to others?’
Pou hihiri, Pou o te aroha | Healing and learning from harm was developed by the Centre of Restorative Justice and Stella Maris productions in consultation with several health sector and Māori partners, and funded by the Health Quality & Safety Commission, ACC and the Centre of Restorative Justice.
The Health Quality & Safety Commission recognises there is an opportunity to improve how we approach harm that has occurred in the health and disability sector, to find resolution in a manner that respects the values and wishes of all people. At times our best efforts to understand what happened during an event of harm have led to more harm through things such as delays, language and processes used. We have seen that resolution can occur for all people through the use of restorative practice and hohou te rongopai, and encourage the sector to consider these approaches in the future.
Ko tētahi kiriata hou, Pou hihiri, Pou o te aroha | Healing and learning from harm, e whakaatu ana i ngā kiritaki, mātanga me ngā kairangahau e kōrero ana mō ngā hua o te whai tukanga haumanu nō muri mai i tētahi mahi whakamamae ka puta i te atawhai hauora. Ka whakaahua i te mahi haumanu me te hohou te rongopai i tā te Māori titiro – ngā tukanga e rua e kī ana ka mamae te tanga me te aha ka raru ngā whanaungatanga.
Ko te tukanga haumanu tētahi huarahi e hui kotahi ai ngā tāngata i pāngia ai ki tētahi mahi whakamamae ki tētahi wāhi āhuru mōwai kia kōrero noa mō te ahatanga me te pānga ki ō rātou oranga, ā, kia whakamārama hoki nā wai te mahi, ā, mā wai hei whakaora, hei ako.
Ko te kōrero tahi te mea nui, te whakarongo atu ā-ngākau nei, te whakawhiti kōrero, te pono, te noho haepapa, te whakamana me te whakaaro ōrite.
Hei tā Jo Wailling, kairangahau ki te Centre of Restorative Justice, Te Herenga Waka, Victoria University of Wellington, ko ngā mahi tirotiro o āianei ki te whakamamae he mea pono, he tika engari ka whakatinanahia ki te tuhi-reta, ki ngā pepa ōkawa, ka mutu, mā tētahi atu anō e whakatau ina mahia rānei te mahi whakamamae.
‘Nō muri mai o te whakamamae mā ngā tukanga e whai atu ana – te whāki, te tirotiro, te whakatau, me te panoni – ka nui atu pea te mamae,’ ko tāna anō.
Hei tā Graham Bidois Cameron, Pou Tikanga ki Hauora a Toi kōrero, kāore te tukanga ō āianei e tautoko ana i te Māori.
‘Me mātua mārama tātou ki te whakaaro nei ko tā tātou pūnaha he pūnaha mōrearea ki ngā whānau Māori, nā reira, kia uru mai te Māori ki te p1ūnaha e kore e tīmata i tētahi wāhi whakapono. Ka tika te mahi a pūnaha ina whakapono te tangata ki te mahi he mahi hei tautoko i a rātou; kāore te Māori e whakapono ana ki tēnei.
‘Ka kaha aro mai te Māori ki tētahi tukanga whakawhanaunga, engari anō te tukanga mōrearea o āianei. Ko tētahi tukanga hohou te rongopai he tukanga whakahoki mana, whakahoki mā te whanaungatanga. Ko tāna he tūhono tāngata me te para huarahi hei whakatau amuamu me ngā mahi kikino ki tā te Māori e mārama ana ki te oranga.’
Hei tā Charlotte Korte from Mesh Down Under – he rōpū tautoko kiritaki e tautoko ana i ngā Kiwi kua whara i te raumata hāparapara – ko te tukanga haumanu ki te mamae raumata hāparapara e ārahina ana e Manatū Hauora ka tukuna te tangata kia kōrero i ngā whakaaro.
‘Ko te rerekētanga o te pānui pūrongo i te noho tahi me te kiritaki hei whakarongo he tino nui. Nā te take raumata hāparapara i huraina he ngaukino, he mamae nunui. E hia kē ngā tau o ō mātou māharahara me te tuki upoko ki te pātū pereki, me te aha kāore he tāngata e whakarongo mai ana.
‘Ahakoa taku kore whakapono ki te tukanga haumanu i te tīmatanga, mōku ake i āianei he mahi tika i te mea kāore he take o te hoki atu, hoki atu me te whakaaro he mea ka panoni. Me mātua tautohu he aha te mahi me mahi, ina arotakengia rānei, he mahi whaitake hei aukati i te mamae,’ ko tāna.
Hei tā Tākuta Andrew Simpson, āpiha matua o mua i Te Manatū Hauora, mā te tukanga haumanu tētahi huarahi e para e tino whakarongo mai ngā mātanga hauora kia mārama ki ngā kōrero mamae o te tangata.
‘He huarahi tēnei kia whakapuaki kare ā-roto te tangata mō te pānga mai o te mamae ki a ai. Ehara i te mea he whakapae ki tētahi tangata.
‘E kore e taea e koe te whakaputa i ōu ake whakaaro tae noa kia rongohia katoatia ngā kōrero me te aha ka kawea koe ki ētahi whakaaro atu anō ina whakarongo anake tki tētahi wāhanga noa iho o te kōrero. Kua pakaru pea tētahi wāhi o te pūnaha; me pēhea e takahuri ai, me pēhea e ako ai kia kore e pā atu anō ki ētahi atu?’
Ko Pou hihiri, Pou o te aroha | Healing and learning from harm he mea whakawhanake nā te Centre of Restorative Justice rāua ko Stella Maris mā te kōrero tahi me ngā tini rāngai hauora me ngā hoa Māori, ā, nā Kupu Taurangi Hauora o Aotearoa rātou ko He Kaupare. He Manaaki. He Whakaaro ko te Centre of Restorative Justice te pūtea tautoko.
Mōhio ana a Kupu Taurangi Hauora o Aotearoa kua whai wāhi ki te whakapai ake i tā tātou e whakaaro ana mō te whakamamae kua puta i te rāngai hauora, rāngai hauā, kia rapua he whakataunga e aroha atu ana ki ngā uara me ngā wawata o ngā tāngata katoa. I ētahi wā, ahakoa tō mātou kaha kia tino mārama ki ngā mahi whakamamae ka kino iho te mamae nā te takaroa, te reo me te tukanga i whāia. Kua kitea e mātou ka taea te mahi whakatau te mahi mō ngā tāngata katoa mā te tukanga haumanu me te hohou te rongopai, ka mutu, he akiaki i te rāngai hei whakaaro ki ēnei tukanga mō ngā tau ki mua.