Forgive, but not forget

Introduction Text:
I’ve been reflecting on quite a challenging concept recently, one that a lot of people have a hard to time coming to terms with; the concept of forgiveness. How often have you heard of or been involved in some type of feud, whether between friends or family, that has lasted slightly longer than necessary? The consequences can be very destructive and often we only move on with a continued sense of frustration or anger, which in turn, can be unproductive.

Managing director, Jan Sobieraj
Managing director, Jan Sobieraj

At work and at home, we are at our best when we feel positive and optimistic. However, when things have gone wrong in the past at work, I wonder how we could have used the role of forgiveness and the process of how we forgave as an important method to improve services? In the world of healthcare, when we know that not everything goes exactly according to plan, how can leaders embed improvement, learning from mistakes and tackling failure in order to keep staff and patients engaged?

The Truth and Reconciliation Commission (TRC) is an initiative that was established to identify the wrong doing by a nation in order to resolve the conflict and tension that was left over from the past. President Nelson Mandella and Desmond Tutu established the TRC after South Africa’s Apartheid. Today, the TRC is now popularly regarded throughout many countries as a successful model for reconciliation, closure and forgiveness. Governments across the world report that TRC can provide a really helpful mechanism for taking a forward step following terrorism, crimes and human rights abuses.

The method involves an open testimony from victims of human rights abuse to reveal their stories and experiences directly to their perpetrator in the hope of moving forward from the past. Often perpetrators respond and share openly what they did and why. So how can this approach to amnesty be used for a quality focused NHS? It is crucial for patients and their loved ones who have suffered from poor patient care to be given the opportunity to speak openly about their experiences to receive the same closure and move forward. In return organisations should be open about what happened, why and what has been done since to avoid future occurrences. So perhaps we shouldn’t or can’t forget, but can we forgive?

It is the duty of all leaders at every level to encourage and demonstrate this openness to both staff and patients. As with the duty of candour, this is not a concept that should wait for guidance, but one that should start immediately, although this often necessitates new leadership skills and approaches.

I would recommend reading up on many of the successful Truth and Reconciliation Commissions that have taken place around the world. I would also welcome your views on how leaders might use their skills to carefully implement a sensible approach and ultimately achieve a greater sense of a forgiving culture to enable better care and quality.

6 replies on “Forgive, but not forget”

  • For some time I have been looking at TRC as a way of everyone telling their story- their truth from their perspective. I think that we need to consider how the NHS can learn from this model when to be honest we will again make mistakes because we are a people business and people make mistakes. I would be happy to pilot this type of initiative in my organisation


    Julie Bolus
    • This is a wonderful idea Julie. Please update us on further development of this and any way we might help.


      NHS Leadership Academy
      • I have just had a proposal for post complaint conciliation that uses such restorative justice models, presented to Northumbria local health authority by the local Care Quality Commissioner. I came up with it after a particularly frightening and bizarre experience as a patient in A and E and in following the complaints process. After this treatment and process, any way of placing trust in them was totally untenable .
        I have suggested an independent service and a model of meetings that includes local organisations who are likely to be part of the complaints process and thus the need for them to be part of the healing process, e.g. charities such as Healthwatch, Age Uk for patients, and staff organisations.
        I am a senior citizen and thus realise that the day I will need emergency treatment gets ever closer. So it is vital that I am able to trust my local health authority and its hospitals.
        I have just found your work now, and am pleased to see that managers are beginning to think this way too. I do hope you will be able to move from the sentiments to the practical solutions quickly, though I suggest it is for others to set up such facilities for you.

        roslyn renwick
  • It’s fantastic that Jan has instigated this discussion because there is no doubt that we need to get better at making amends after things go wrong in health and social care. However, I also think much more is known now about “moral repair” than was known at the time of the TRCs. They were a brilliant and brave experiment, and fulfilled what we now know are some fundamental requirements. These were (for example) acknowledging the facts of mistreatment; treating the victims as people with a ‘moral voice’ that should be heard; acknowledging injury; acknowledging shared moral norms (such as the value of every human being, whatever race or colour). But they were also a particular response at a particular time in history and a couple of the needs they left unfulfilled was the need for restitution and acknowledging the “righteous” anger of those who had been harmed. Because these needs were not met, and because the new S. African political system has failed to deal with internal corruption, part of the TRC ‘heritage’ is victims of the former regime who increasingly feel angry and betrayed. Restitution does not have to be money compensation – the best restitution can be ensuring that things change in the aftermath of harm and that people (such as victims of apartheid or patients and carers) see that things have truly changed for the better. We need to be really clear that there is no “cheap grace”. Glossing over harm will not do. What “moral repair” demands is genuine recognition of wrongs, genuine acceptance that the person or institution that has done the wrong does not have the right to say how to behave or when “it is over”, and genuine changes to ways of behaving. Anyone who’d like to know more about this can contact me via twitter @ethicsconsult. My profile also has a link to the (free) google preview of my book where I’ve discussed moral repair after healthcare harm at length.

    Suzanne Shale
  • I can appreciate to possible benefits of honest dialogue. However there is a considerable journey to be made by nurses to initially be honest with themselves, about their own attitudes and its effects on their care behaviours. Also perhaps it is time for honesty/ debate about what we can realistically provide with the budget available. Also ranting NHS (or other provider) bashing in the press does nothing to encourage a proper debate about care/ value for money/ or quality.

    Meriel Chudleigh
  • Thanks for starting this interesting discussion. We have seen some positive results from workshops aimed at helping nurses to examine “intentions and perceptions” of perpetrators and victims in non physical conflict situations on inpatient wards. We use forum theatre to prompt thinking around own and alternative attitudes/beliefs. We have found conflict often occurs in this environment due to misperceptions- it is much easier to forgive and make amends when there is an appreciation of the intentions or perceptions of “the other”.

    Sue mclaughlin

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