Background: Healthcare is not without risk. Despite two decades of policy focus and improvement efforts, the global incidence of harm remains stubbornly persistent, with estimates suggesting that 10% of hospital patients are affected by adverse events. Methods:We explore how current investigative responses can compound the harm for all those affected-patients, families, health professionals and organizations-by neglecting to appreciate and respond to the human impacts. We suggest that the risk of compounded harm may be reduced when investigations respond to the need for healing alongside system learning, with the former having been consistently neglected.Discussion: We argue that incident responses must be conceived within a relational as well as a regulatory framework, and that this-a restorative approach-has the potential to radically shift the focus, conduct and outcomes of investigative processes. Conclusion:The identification of the preconditions and mechanisms that enable the success of restorative approaches in global health systems and legal contexts is required if their demonstrated potential is to be realized on a larger scale. The policy must be co-created by all those who will be affected by reforms and be guided by restorative principles.Patient or Public Contribution: This viewpoint represents an international collaboration between a clinician academic, safety scientist and harmed patient and family members. The paper incorporates key findings and definitions from New Zealand's restorative response to surgical mesh harm, which was co-designed with patient advocates, academics and clinicians.

Aim This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design Instrumental, embedded case study design using qualitative methods. Methods The study used purposeful sampling, and data was collected using focus groups and semi‐structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence‐based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.

Background Safety systems are socio-cultural in nature, characterised by people, their relationships to one another and to the whole. This study aimed to (1) map the social networks of New Zealand’s quality improvement and safety leaders (2) illuminate influential characteristics and behaviours of key network players (3) make recommendations regarding how networks might be optimised. Methods Instrumental case study using mixed methods. Purposeful sampling was applied to collect survey data from delegates at two national safety and quality forums (n=85). Social network questions asked respondents who influenced their safety work. Key network players were identified and invited to participate in a semi structured interview (n=7). Results Key players described safety systems in humanistic terms. Safety influence was determined to be a responsive relational process. Adaptive leaders broker relationships between multiple perspectives and contexts, which is essential for safe healthcare. Conclusion Influential safety approaches appreciate the human contribution to safety. Designing the health system to adapt and respond to the needs of people, teams, and communities, rather than the unilateral needs of the system is essential. Adaptive leadership will assist in achieving these aims and will likely be embraced by New Zealand health professionals.