Restorative Just Culture: a Study of the Practical and Economic Effects of Implementing Restorative Justice in an NHS Trust

Abstract

Restorative justice is an approach that aims to replace hurt by healing in the understanding that the perpetrators of pain are also victims of the incident themselves. In 2016, Mersey Care, an NHS community and mental health trust in the Liverpool region, implemented restorative justice (or what it termed a 'Just and Learning Culture') to fundamentally change its responses to incidents, patient harm, and complaints against staff. Although qualitative benefits from this implementation seemed obvious, it was also thought relevant to identify the economic effects of restorative justice. Through interviews with Mersey Care staff and collecting data pertaining to costs, suspensions, and absenteeism, an economic model of restorative justice was created. We found that the introduction of restorative justice has coincided with many qualitative improvements for staff, such as a reduction in suspensions and dismissals, increase in the reporting of adverse events, increase in the number of staff that feel encouraged to seek support and a slowing down of the upward trend in absence due to illness. It also improved staff retention. The economic benefits of restorative justice appear significant. After corrections for inflation, acquisitions and anomalies, we found that the salary costs averaged over two fiscal years were reduced by £ 4 million per year, coinciding with the introduction of a just and learning culture in 2016. In addition, Mersey Care reaped around £ 1 million in saved legal and termination expenses. We conservatively attribute half of these savings to the introduction of a just and learning culture itself, and the other half to non-related factors. Using this assumption, we estimate the total economic benefit of restorative justice in the case of Mersey Care NHS Foundation Trust to be about £ 2.5 million or approximately 1% of the total costs and 2% of the labour costs.

Inconvenient truths in suicide prevention: Why a Restorative Just Culture should be implemented alongside a Zero Suicide Framework

“…A peer led, non-punitive, restorative response has proven more successful in changing behaviour towards a safer system (Dekker, 2016). Implementing RJC has also been found to be cost effective (Kaur et al, 2019).…”

Leadership in the NHS

“…Progress on the ‘compassionate and inclusive’ treatment of staff may be seen as too difficult for many teams and organisations, especially if the behaviours of national bodies do not match their exhortations to local bodies. Yet, the evidence is that when sustained evidenced interventions, applying ‘human factors’ science and incentivising a learning culture not blame, replace a retributive culture with a restorative one, there are very substantial gains for staff and substantial benefits to organisations, saving 2% of staffing costs in one Trust 16…”

Paradigm lost? Reflections on the effectiveness of NHS approaches to improving employment relations

“…First, large numbers of employers now insert an accountability nudge (or bias interrupter) at the ‘point of incident’ requiring line managers considering launching an investigation to pause and explain to a senior manager why a formal investigation rather than an informal discussion is appropriate, often linked to awareness of risk of racial bias. Second, a increasingly adopted ‘just culture’ initiative in Mersey Care NHS FT emphasising early informal intervention alongside learning not blame has incentivised a learning culture, replacing a retributive culture with a restorative one, also leading to substantial financial savings 34…”