Restorative and relational practice and patient safety: A blog by Lesley Parkinson

Summary

The current consultation by the Department of Health and Social Care, ‘Leading the NHS: proposals to regulate NHS managers’ defines professional standards as “…the values, behaviours and competencies that managers will be expected to demonstrate.” In this blog, Lesley Parkinson, Executive Director at Restorative Thinking, and author of 'Restorative Practice at Work', explains what restorative and relational practice is and why this needs to be explicitly written into the professional standards being developed to improve relationships and accountability.

Content

There is currently not a set of recognised professional standards for NHS managers and I understand that NHS England is in the process of developing these.

My hope is that restorative and relational practice will be included. This consists of a set of principles, processes and skills that guide our thinking, language and behaviours, and help us to continually build and improve our relationship skills. The graphic below gives a little more detail about what restorative and relational practice offers:

If these behaviours and processes can be coherently and explicitly written into the professional standards being developed, they will go some way to improving relationships and accountability. This will have a positive impact on patient safety, as there will be less likelihood of people carrying grudges, feeling that things aren’t fair and other emotional distractions that prevent us from giving our full attention to the patients in front of us.

There is already some guidance around workplace behaviours in the NHS; ‘compassionate leadership’ and ‘civility and respect’ spring to mind. Restorative and relational practice adds the detail of processes and language to deliberately foster equality of voice and respectfully challenge each other when we see, hear or feel something that isn’t right; this could be the way someone speaks to us or something we observe taking place that looks wrong or unsafe.

Approaching someone in order to challenge them is a key relationship skill that needs deliberate and specific attention. If our approach is accusatory, we will likely meet a defensive or argumentative response; this interaction could damage a relationship immediately and in the long term. Restorative and relational practice helps us to navigate this tricky territory so that we learn how to respectfully challenge each other: to pause judgement; invite perspectives; discuss feelings and expectations; end with a solution in which there’s clear accountability and agreement.

The Restorative Thinking team is currently delivering workshops with NHS trusts to develop these particular skills, but I’m afraid there’s no quick fix. The language and processes we use are based on a group of psychological and behavioural sciences and it’s key that we understand and grasp these before putting the theory into practice. New research from the Imperial College Business School shows how leaders can make constructive challenge not just possible but an integral part of a thriving organisational culture.

In terms of the current Department of Health and Social Care consultation, I’ve observed the most effective regulation is done within teams and departments, person to person. It's clear that too many leaders, managers and staff lack the relationship skills to regulate each other; this is what needs to be addressed so that all NHS staff (whatever their role) can give their full attention to patient care and patient safety.

The good news is that the Restorative Thinking team is developing learning options: podcasts, videos and paper resources, to help facilitate this ‘relationships education’ and we are building a self-guided learning page on our website to be launched in 2025.  We already offer a short e-learning course and we've started to publish freely available podcasts on this theme. We are also partnering with the organisation AQUA to help NHS organisations to design and deliver safer care for patients by including restorative and relational practice into staff inductions, staff training, organisational development and Board development sessions.

About the Author

Lesley Parkinson is Executive Director at Restorative Thinking and author of the book: Restorative Practice at Work.

@Re-Think.bsky.social

[email protected]