Healing pain of surgical mesh
A world-leading approach to addressing the trauma caused by surgical mesh has provided a pathway for the wider health system.
Healthcare is an inherently risky business. The global incidence of harmful events is stubbornly persistent, with about 10% of hospital patients affected each year.
When something goes wrong and someone is hurt or injured, the effort put into investigating who or what is to blame often overshadows the needs of the people involved.
By not appreciating and responding to the needs of patients and practitioners, current investigative responses can make things worse and compound the harm experienced by the people involved.
But healing after harm is possible within a relational framework, as the restorative response to the surgical mesh issue shows.
The recent release of the report Healing after Harm: an evaluation of a restorative approach for addressing harm from surgical mesh, published by Te Ngāpara Centre for Restorative Practice at Te Herenga Waka – Victoria University of Wellington, points to a more effective way of responding to healthcare harm.
The upcoming reforms of New Zealand’s health system offer a chance for this successful approach to be used more widely.
Surgical mesh is amedical device used to repair and provide support to parts of the body that have become weakened. Its use, especially in urology, gynaecology, and hernia surgical procedures, has been an issue of global concern for some years. Mesh complications can be life-changing and include chronic pain, infections, and organ damage.
In 2019, the Ministry of Health, advocacy group Mesh Down Under and Te Ngāpara Centre for Restorative Practice co-designed a restorative approach to surgical mesh harm, which aimed to restore wellbeing, relationships, and trust.
As the first large-scale restorative response within a health system, there is national and global interest in how it was designed and how well it worked.
Through the restorative process, more than 600 New Zealanders shared their stories of the harm they suffered due to complications from surgical mesh, either in one of 32 Listening Circle forums held throughout the country or in an online story database. Health professionals, and the family and whānau of mesh-injured people, also shared their experiences.
Mesh-injured New Zealanders reported their suffering was made worse by adversarial processes used by the healthcare system to respond to the harm caused. The simple act of listening to experiences and hearing what people needed achieved much more.
The evaluation found that: a restorative response was experienced as validating and dignifying; multiple methods of storytelling ensured a safe and supportive environment for most people. Hearing directly from the people affected inspired those responsible for change to collaborate and take steps to fix and prevent problems.
Along with action to address harm from surgical mesh, the approach has the potential to address healthcare harm in the wider healthcare system in a new way.
Restorative systems work by giving equal consideration to the needs of all people affected, regardless of their role or status. They distribute leadership amongst communities, advocates, and agencies, and promote equity of voice for all the people who provide or receive care.
In such a system, people are accountable to each other and take responsibility for clarifying obligations and responding to needs.
While ACC’s no-fault approach to compensation for treatment injury is envied by international safety advocates, the surgical mesh project illustrated the ACC process can make things worse, and that compensation and psychological support are not as easy to access as we might think. The increasing number of complaints to the Health and Disability Commissioner – up 14% in the year to June 2021 – also indicates growing dissatisfaction with (or mistrust of) health providers’ responses to consumer concerns.
Importantly, restorative responses resonate with the relational approach of te ao Māori and have more to offer New Zealand than existing investigative methods. Restorative relationships maintain and enhance dignity or tapu, and people feel seen and heard as though they matter – both when all is well and in the aftermath of a harmful experience.
The success of the restorative approach in the surgical mesh inquiry shows that a relational approach has wider potential to address healthcare harm. The health and disability sector reforms provide the opportunity to embed restorative approaches to reinforce Te Tiriti oWaitangi principles and enable people-centred and more equitable responses to healthcare harm.
Jo Wailling RN and Graham Cameron are senior research fellows with Te Ngāpara Centre for Restorative Practice, which carries out research in healthcare and other sectors; Dr Andrew Simpson was formerly the chief medical officer at the Ministry of Health; Carmel Berry is the creator of advocacy group Mesh Down Under; and Dr Iwona Stolarek was formally the Medical Director at the Health Quality and Safety Commission.