Restorative practice and surgical mesh
An evaluation of a restorative approach to address harm from surgical mesh.
Research evaluating the restorative process
The Ministry of Health has published an evaluation of a restorative process designed to listen to, understand, and address the harms that New Zealanders have suffered from surgical mesh use.
The report is titled ‘Healing after Harm: An evaluation of a restorative approach for addressing harm from surgical mesh, Kia ora te tangata: He arotakenga i te whakahaumanu'. It was commissioned from a team of researchers at Te Herenga Waka—Victoria University of Wellington’s Te Ngāpara Centre for Restorative Practice.
The research evaluated the experiences of 230 people who took part in the restorative process. Its aim was to find out if the project objectives were met and if a restorative approach could be used in other health contexts.
The evaluation determined that a restorative approach met substantive, psychological, and procedural needs during the Listening and Understanding phase of the project. Most participants said their dignity was preserved, their experience was validated, and their communications were respectful.
The massive extent of harm and injury after surgical mesh procedures was powerfully communicated. This inspired the responsible parties to collaborate and undertake actions for repair and prevention.
However, many consumers were largely unaware of progress on the 19 actions that resulted from the Planning and Acting phase of the project and were unsure if their needs would be met in the future.
The report concludes that restorative approaches are potentially transferable to other health contexts, if the critical success factors are met. Healing after harm is possible when approached within a relational framework. Which should be embedded alongside existing regulatory structures, policies, and procedural responses.
The report is an evaluation of the restorative process and its immediate impacts. Te Ngāpara Centre for Restorative Practice plans to conduct an independent evaluation of outcomes.
About the restorative process
The restorative process was co-designed in 2019 by the Ministry of Health, advocacy group Mesh Down Under, and researchers and facilitators from Te Ngāpara Centre for Restorative Practice at Te Herenga Waka—Victoria University of Wellington.
The design was informed by an independent analysis of a public survey carried out in early 2019. Respondents were provided with different options, so they could share their story in a way that was meaningful to them.
The restorative process was conceptualised in terms of the individuals and relationships affected. This process enabled the Ministry of Health to hear and understand the lived experiences of New Zealanders affected by surgical mesh harm.
Learnings from this process could be used to inform reparative action and prevent future harm. It may be the first time a restorative approach has been applied to a national healthcare issue in New Zealand or anywhere in the world.
Three phases
A restorative approach to surgical mesh harm was delivered in three phases from July to December 2019. The phases were:
- Listening and Understanding
- Planning and Acting
- Reporting and Evaluating.
A description of each phase can be found in the project report on the Ministry of Health website: Hearing and Responding to the Stories of Survivors of Surgical Mesh or in the short video below.
Experienced restorative practitioners supported participants during each phase of the project. The approach was adapted in response to the emergent needs of individuals, groups, and responsible parties.
Listening and Understanding phase
The ‘Listening and Understanding’ phase of the restorative process invited input from mesh-injured New Zealanders and their family and whānau. They shared their lived experience of surgical mesh harm with the people responsible for repair and prevention. Over 600 women and men shared their experiences in 32 Listening Circles, facilitated meetings, and a Story Database. Additional stories were provided by health professionals.
Planning and Acting phase
The ‘Planning and Acting’ phase brought people from the organisations identified as responsible parties to clarify responsibility for the harms that had occurred and resolve together how best to promote repair and bring about positive changes for all involved. Eventually 19 actions were agreed upon and documented in the final report. Responsibility for ongoing governance and delivery sits with the Mesh Round Table, which has been operating since 2017.
You can find about progress on the actions to date on the Ministry of Health website.
2019 report
The Ministry of Health released the report ‘Hearing and Responding to the Stories of Survivors of Surgical Mesh’ in December 2019. The report details the severity of the physical and psychosocial harms that New Zealanders suffered as a result of surgical mesh use. Many people described these as ‘life changing’.
This report describes how harm was compounded by the professional and agency responses that followed. It also describes the resulting loss of trust in healthcare providers and public institutions. The report includes the reparative and preventative actions agreed within the Planning and Acting phase.
About the evaluation
Aims
The descriptive evaluation was co-designed and had several aims:
- to ascertain whether good practice was demonstrated by the project delivery team
- to understand people’s experiences of the process
- to find out whether the project objectives were met
- to assess whether the approach could be used elsewhere in the health and disability sector.
Ethics approval for the research was granted by the Human Ethics Committee at the University.
Researchers
The researchers on this project included:
- Jo Wailling RN, a senior research fellow at Te Ngāpara Centre for Restorative Practice, who led the co-design, research, and evaluation of the surgical mesh project from its inception
- Emeritus Professor Chris Marshall, the previous Diana Unwin Chair in Restorative Justice, who was the academic supervisor for the project
- Dr Jill Wilkinson RN, in her previous role as a research fellow at Te Ngāpara Centre for Restorative Practice.
Methodology
The researchers evaluated the process and immediate impacts of the restorative approach within a health assessment framework. They used surveys and interviews to collect information from 230 consumers and responsible parties about their experiences. The questions researchers asked were informed by an analysis of what people said they hoped the project would achieve during the registration process.
The COVID-19 pandemic delayed data collection, which eventually took place from May to July 2020. The report was submitted to the Ministry of Health in December 2020.
Conclusions of the evaluation
The evaluation concluded that:
- The restorative process met people’s needs during the Listening and Understanding phase of the project. Most participants expressed that they experienced respectful communication, the preservation of their dignity, and validation of their experience. Restorative Circles were particularly effective.
- The massive extent of the harm caused by surgical mesh was powerfully communicated, and the responsible parties were inspired to collaborate and undertake actions for repair and prevention.
- After the Planning and Acting phase had ended, the majority of consumers were unaware of the actions taken by the Ministry of Health and other responsible parties. Many are still unsure what actions have been undertaken to further reduce risk to patients and support people who have been harmed by surgical mesh.
- Restorative approaches are potentially transferable to other health contexts, if the critical success factors are met.
- Healing after harm is possible when approached within a relational framework. This should be embedded alongside existing regulatory structures, policies, and procedural responses. A collaborative approach to design—one that distributes leadership amongst communities, advocates, and agencies—will promote success and build trust.
- Restorative approaches resonate with the relational approach of Te ao Māori and have more to offer Aotearoa New Zealand than traditional investigative methods.
- Ongoing testing and refining of restorative approaches in different contexts will be important to understand what works for whom, in what contexts, and how.
Summary comments
The co-designers of the restorative process and the evaluation thanked all who participated in the process and in the evaluation.
Jo Wailling noted, “We would like to take this opportunity to express our gratitude to mesh-injured patients and their families and whānau for their generosity. We heard that sharing your stories with us often took great courage and effort. We would also like to extend our thanks to the clinicians and agency representatives who shared their experiences so candidly.
She continued, “We hope the initial report, and this subsequent evaluation, illustrate how responses to healthcare harm can be changed to better meet the needs of all New Zealanders. Our work will continue, focusing on how restorative responses can support the person-centred approach desired in the upcoming health reforms.”
Shared stories
A Ministry of Health source said, “We are grateful to everyone who made the decision to share their story with us. As one participant said, ‘despite everything that people had lost, people came along to talk to us in a very clear-minded and often fair-minded way. And for everything that had been destroyed, people’s humanity was still intact’. We are grateful to our co-design partners—advocacy group Mesh Down Under and the University—for their work to create a space that most people found to be safe to share their story.”
Sharing the report
Research participants were provided with the executive summary of the report in December 2021.
The report has been shared with those who took part in the process, and with agencies and organisations involved in the restorative justice process. The report is publicly available on the Ministry’s website.
The National Collaborative for Restorative Initiatives in Health
The evaluation report concluded that restorative approaches should be embedded alongside existing regulatory structures, policies, and procedural harm responses. Since 2020, the National Collaborative for Restorative Initiatives in Health has been operating to explore how restorative initiatives might be co-designed within a Te Tiriti o Waitangi framework. Membership represents cross-sector agencies, kaumātua and kuia, and those providing perspectives from the sharp end of care provision, such as consumers and clinicians.
You can read the reports that detail the approach used and the subsequent evaluation.
Mesh Down Under
"Working with Jo and the team at Victoria University of Wellington has been the highlight of my advocacy role. After years of fighting with various agencies to get the recognition that surgical mesh has caused serious harm to our community, the restorative process gave a respected voice to patients and whanau. At all times in the co-design process, I have felt acknowledged as an expert contributor." (Carmel Berry Consumer Advocate and Creator Mesh Down Under)